Vascular Flashcards
Define TIA
Acute loss of focal cerebral function with symptoms lasting for less than 24 hours
No apparent cause other than vascular origin
What % of strokes are caused by ischaemia?
80%
What are the potential pathologies of the carotid artery?
Carotid thromboembolism
Small vessel disease
Cardiac embolism
Haematological
What are the features of a stroke of carotid origin?
Hemisensory or hemimotor deficit
Monolateral blindness
Higher cortical dysfunction e.g. Expressive dysphasia, visuospatial neglect
What are the features of a vertebrobasilar stroke?
Hemisensory or hemimotor deficit Bilateral motor/sensory Bilateral blindness Dysarthria Veering to one side Ataxia/unsteadiness Homonymous hemianopia
What features indicate that the patient has not had a TIA?
Isolated diplopia
Isolated vertigo
Isolated dizziness
(pre)syncope
What grade of carotid stenosis requires surgical intervention?
High-grade: over 70%
What are the aspects of optimal medical management for carotid artery disease?
Anti platelet Blood pressure Statin therapy Diabetic management Angina Lifestyle advice
Describe carotid endarterectomy
Carotid artery cut at its bifurcation
Temporary shunt inserted to avoid the surgical site
Plaque removed
Artery sutured
What nerves may be damaged during carotid endarterectomy?
Vagus CNX
Hypoglossal CNXII
Ansa (part of cervical plexus)
What are the potential risks of carotid endarterectomy?
Stroke (3%)
Nerve damage - especially hypoglossal (3%)
When is surgery used for asymptomatic carotid disease?
70-99% stenosis
Otherwise fit males
What are the potential benefits of carotid angioplasty rather than endarterectomy?
Less invasive
No neck incision
No risk of cranial nerve injury
Define aneurysm
A permanent localised dilatation of an artery
More than 50% of the normal diameter of the artery
Define ectasia
Localised area of enlargement in the artery but less than 1.5x
What is a true aneurysm?
All 3 layers of the arterial wall involved
What is a false aneurysm?
Leakage of blood out of an artery into a cavity surrounded by connective tissue, that is expansile and Pulsatile
Where is the most common site for an abdominal aortic aneurysm?
Infra-renal AA
What is the normal diameter of the male abdominal aorta?
1.5 - 2 cm
Define an infra-renal AAA
Diameter > 3 cm
What % of elderly males have an AAA?
5%
At what rate do AAAs commonly expand?
10% per year
What factors influence rupture of AAAs?
Blood pressure
Smoking
What is the most common presentation of an AAA?
Majority are asymptomatic