Vascular Disease Flashcards
What is the adult prevalence of intracranial aneurysms?
2%
What is the mortality rate of ruptured aneurysms?
30-40%
What percent of ruptured aneurysms develop hydrocephalus?
15-20%
What percent of ruptured aneurysms develop cardiac issues?
50%
Summarize the rupture risk for aneurysm size based on the International Study of Unruptured Intracranial aneurysms? What kind of study was it?
prospective cohort
What is the associated between Hunt Hess and clincal outcomes? Vasospasm?
What is the World Federation of Neurosurgery grading scale?
What is the modified fisher grade and what is the association with vasospasm?
What percent of bacterial endocarditis patients have mycotic aneurysms?
5-15%
What were the conclusions of the Internation Subarachnoid Aneurysm Trial (ISAT)?
Initially, large difference in mortality favoring coiling over clipping at 1 year. At 5-year follow-up, no difference in mortality between the two groups, though the incidence of rebleeding and aneurysm recurrence was higher in the coiling group
What were the conclusions of the Barrow Ruptured Aneurysm Trial?
initial results at 1 year favoring coiling with regard to poor outcome. At 3-year follow-up, no difference between groups. The rate of recurrence, rebleeding, and aneurysm obliteration were better in the clipping group
What are the general morbidity and mortality for coiling and clipping aneurysms?
mortality (1–2% for surgery/
coiling) and morbidity (4% coiling and 8% surgery)
What is the Spetzler Martin grading system?
What are the outcomes for AVMs based on Spetzler Martin grade? Explain in terms of morbidity with surgery, radiosurgery, and obliteration percent.
What is the hemorrhage rate for AVMs?
2-4% per year, 6–18% in first year following initial hemorrhage if not treated. Lifetime risk of hemorrhage is 17–90%.
What is the mortality of AVM hemorrhage?
mortality 10–30%, morbidity 10–30%.
What are dural AVFs?
Pathological shunts between meningeal or extracranial arteries and the dural venous sinus, dural veins, or cortical veins
What is the Borden classification for dAVFs?
Borden I: Generally benign (conversion rate to higher grade ~ 2%), but occasionally symptoms warrant treatment.
Borden II: Hemorrhage in 18%, annual hemorrhage rate of 6%.
Borden III: Present with hemorrhage in 34%, annual hemorrhage rate of 10% which increases to 21% with venous ectasia.
What endovascular treatment is preferred for dAVF?
transvenous coiling
What is the Cognard classifcation system?
Moyamoya in asian adults usually causes _____ while in children usually _____. In American adults, it usually presents as ____.
hemorrhage
ischemia
ischemia
What is the difference between moyamoya disease and syndrome?
disease: idiopathic
syndrome: secondary
What is the grading system for moyamoya disease on angiography? What does it consist of?
What is the risk of hemorrhage in cav mals?
Risk of symptomatic hemorrhage 0.5–2% per year, may be higher in patients with previous hemorrhages (~5% per year), deep lesions (~10% per year), posterior fossa lesions, familial inheritance, and women (~4% per year)
What does the ICH score predict? What are those values?
mortality at 30 days
ICH score
0: 0%
1: 13%
2: 26%
3: 72%
4: 97%
5: 100%
6: 100%.
What were the conclusions fo the STICH I and II trials?
supratentorial ICH surgical evacuation only mild benefit in long term mortality
What were the conclusions of the MISTIE trial?
minimally invasive clot aspiration + tPA: 50% reduction in clot burden and at 6 and 12 months increase in number of patients in mRS 0–3 category versus mRS 4 and above
What were the results of the CLEAR trial?
clot lysis of IVH with tPA through external ventricular drain (EVD): mortality rate of 18% in treatment group vs 23% in placebo group, similar ventriculitis rates ~8–9%
Malignant cerebral edema presents in what percent of MCA infarcts?
10%
What is the prevalence of carotid stenosis in the population?
2.5% for age < 65, 35% for age > 75
Summarize the literature on carotid stenosis management, medically vs surgically.
What percent fo CCFs are from trauma?
70%
What are the types of CCFs?
direct (carotid artery)
indirect (adjacent branch)
What is the presentation for CCFs?
Direct: orbital/retro-orbital pain, chemosis, pulsatile proptosis, ocular/cranial bruit, visual deterioration, diplopia, and ophthalmoplegia.
Indirect: more insidious onset. Conjunctival injection is most prominent feature
What is the management of low flow CCFs?
can be watched until they spontaneously thrombose if visual acuity stable and intraocular pressure < 25 mm Hg. Can also perform daily manual compression of cervical ICA
