Vascular

Question 1

What is the Stanford classification of aortic dissection?

Answer 1

Stanford A: involves ascending ± descending aorta
Stanford B: involves descending aorta only

Question 2

What is the Debakey classification of aortic dissection?

Answer 2

Debakey I: involves BOTH ascending an descending aorta
Debakey II: Ascending only
Debakey III: Descending only

Question 3

List the clinical features of a aortic dissection (6)

Answer 3

Symptoms
- Sudden onset, severe, stabbing chest pain
- Pain radiates to back/abdomen
- ACS
- Syncope

Signs
- Tachycardia
- New diastolic murmur (AR)
- Differential pulses
- ACS
- Hyper/Hypotension
- Stroke

Question 4

Is there a specific biomarker for aortic dissection?

Answer 4

Smooth muscle myosin heavy chain protein
(not widely available)

Question 5

What is a good target BP for management of acute aortic dissection?

Answer 5

110-120 mmHg systolic

Question 6

What is the first line management for hypertension in acute aortic dissection?

Answer 6

Beta blockers:
Labetalol 50mg over 1 min IV push with infusion of 1-2 mg/min titrated to response
Esmolol 500 mcg/kg over 1 min with infusion of 50-200 mcg/kg/min titrated to response. Bolus as above for each infusion dose adjustment.

Question 7

What is NASCET?

Answer 7

North American Symptomatic Carotid Endarterectomy Trial

Question 8

What did NASCET show?

Answer 8

For 50 - 69% stenosis:
NNT = 10 to prevent stroke or death at 30 days
NNT = 15 to prevent ipsilateral stroke at 5 years

Question 9

What is ECST?

Answer 9

European Carotid Surgery Trial

Question 10

What did ECST show?

Answer 10

For 80-100% stenosis:
NNT = 9 to prevent major stroke/death at 3 years

Question 11

What are the NICE recommendations for CEA following TIA?

Answer 11

Perform within 2 weeks (48 hours preferable)