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Tax > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Which modality is the gold standard for preoperative assessment of patients for carotid intervention

A

Arteriography

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2
Q

What other modalities are used for cerebrovascular disease

A 
Plain CT
Contrast arteriography
MRA
CTA
Digital subtraction CTA
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3
Q

What does non-invasive mean

A

No contrast agents

No catheter related complications

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4
Q

What is arteriography used for

A

Catheter based technique
Stroke/death rate 0.2%-0.7%

This does not answer the question..oops

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5
Q

What do we assess with arteriography

A

Aortic arch, SCA, and carotids (int and ext)

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6
Q

Plain CT

A

Provides 2 and 3 dimensional images to identify silent infarcts, determining the timing of surgery, evaluating the risk of surgery, and r/o other causes of disease or symptoms

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7
Q

What is CTA good for

A

Highlights the cerebrovascularity

Invasive –uses contrast

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8
Q

What method visualizes the entire cerebral arterial system

A

Digital subtraction

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9
Q

Is MRA preferred over duplex and angiography?

A

No

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10
Q

What is the downside for MRA

A

It can overestimate the extent of the disease in turbulent flow areas

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11
Q

Is MRA invasive?

A

No

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12
Q

Angioplasty

A

Technique of mechanically widening narrowed or obstructed arteries
Usually because of arteriosclerosis

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13
Q

What is the process for an angioplasty

A

Empty and collapsed ballon on a guide wire (balloon catheter) is put into the narrow location
Inflated using water pressure to 75-500x normal
Balloon expansion of inner plaque and muscle wall
Balloon is then deflated and removed, and a stent may or may not be inserted at this time

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14
Q

What happens to the Doppler signals post stenting?

A

Alteration in biochemical properties
Can cause increase in velocities
Turbulence can be expected

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15
Q

Is an abrupt increase in PSV normal ?

A

No–should be gradual

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16
Q

PSV can increase throughout the patent area up to

A

150cm/s

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17
Q

A velocity increase across the stent at a __:___ ratio identifies a degree of _______

A

2:1, restenosis

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18
Q

Why is the stent assessed after the procedure?

A

To look for intimal thickening, restenosis, or plaque/thrombus formation

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19
Q

What’s the criteria for CEA (endarectomy) and CAS (stenting)?

A

Symptomatic- 50-99%

Asymptomatic- 60-99%

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20
Q

The risk of stroke/death in asymptomatic patients for a procedure must be

A

< 3%

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21
Q

When should CAS be done in asymptomatic patients?

A

When they’re at high risk for intervention or with a life expectancy of < 3yrs

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22
Q

What’s the grading criteria of those with a 50-69% stenosis?

A

PSV >125cm/s
EDV <110cm/s
Ratio >2 <4

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23
Q

What’s the grading criteria of those with a 70-79% stenosis?

A

PSV >270 cm/s
EDV >110 cm/s
Ratio >4

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24
Q

What’s the most important thing that should be ruled out following revascularization?

A

Restenosis

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25
Q

PSV ratio measurements are taken

A

Pre and during stenosis

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26
Q

What are the complications associated with CEA:

RRODHIPI (acronym)

A 
Intimal flap
Dissection
Residual plaque at the end of CEA site
Occlusion
Infected patch 
Hematoma
Pseudoaneursym
Restenosis
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27
Q

What Doppler (C and P) signs will you see with a PSA?

A

Yin Yang

To-and-fro

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28
Q

What does coarctation mean

A

Narrowing

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29
Q

Where is aortic coarctation most common?

A

Aortic arch– usually where the ductus arteriosus inserts

Can be pre or post ductal

30
Q

What amount in pressure difference can be used to assess efficacy of surgical intervention?

A

70mm/Hg

31
Q

Patients with coarctation of the thoracic aorta may not have claudication and little/no change in ankle pressure following exercise. True or false

A

True–because of collaterals

32
Q

What’s the treatment for coarctation?

A

Angioplasty or end-to-end anastomosis (removes narrowed portion)

33
Q

What are common causes of stroke?

A

Atrial fibrillation
Hardening of arteries
High BP

34
Q

What are the less common causes of stroke

A

Vasospasm
FMD
Radiation induced vasculopathy

35
Q

Ischemic stroke

A

Occur as a result of an obstruction within a blood vessel supplying blood to brain

36
Q

What’s the underlying condition of ischemic stroke?

A

Arteriosclerosis

37
Q

What are the 2 types of obstruction that can occur with ischemic strokes?

A

Cerebral thrombus

Cerebral embolism

38
Q

Cerebral thrombosis:

A

refers to a thrombus that develops at the clogged part of the vessel in the brain (from arteriosclerosis)

39
Q

Where is a cerebral embolism typically from?

A

Heart or large arteries–such as carotids

40
Q

Vasospasm causes

A

Restriction in blood flow

41
Q

Cerebral (brain) vasospasm may happen after an operation for a bleed that occurs between the brain and the thin tissue covering the brain (subarachnoid hemorrhage). Vasospasm typically occur ________ days after subarachnoid hemorrhage.

A

4-10

42
Q

AVM:

A

Tangle of blood vessels where blood bypasses the tissue and goes straight from arteries to veins

43
Q

AVM’s are more common in

A

Men

44
Q

Over 15 years, the total chance of an AVM bleeding into the brain, causing damage and stroke is

A

25%

45
Q

AVM’s cause patients to experience what?

A

Localized pain in head due to increased blood flow

46
Q

Cerebral aneurysm is

A

Weak or thin spot on a blood vessel in the brain that balloons and fills with blood. This can put pressure on a nerve or surrounding tissue

47
Q

Brain aneurysms only occur in those over 40. True or false

A

False, can occur at any age

also mostly women

48
Q

Cerebral aneurysm most commonly occur in people 40-60years of age. True or false

A

False – 30-60

49
Q

What are the risk factors of CA?

A

Hypertension
Alcohol abuse
Drug Abuse–cocaaaine
Smoking cagrettes

50
Q

More commonly, cerebral aneurysm ruptures can cause a

A

Subarachnoid hemorrhage–space between bone and brain

51
Q

What is the most common type of arrhythmia?

A

Atrial fibrillation

52
Q

What is the significance of atrial fibrillation?

A

Blood pools in atria and is not completely pumped to ventricles. Stasis causing clotting, thrombus forms and embolism ensues

53
Q

CHF is treated with?

A

Anticoagulation therapy

54
Q

CHF is associated with thrombus formation and risk of stroke how?

A

Hypercoagulable state

55
Q

Which side of the heart is a thrombus more aggressive?

A

Right – needs embollectomy or lytic therapy

56
Q

What is the most common cause of stroke in young adults?

A

Carotid artery dissection

57
Q

What are the 2 classes of CA dissection?

A

Spontaneous

Traumatic

58
Q

What may occur simultaneously as the dissection may be through the tunica adventia?

A

PSA

59
Q

What is treatment for carotid dissection?

A

Observation, anti-coagulation, stent implantation and carotid artery ligation

60
Q

Severe flow disturbances in a dissection are caused by

A

Intimal flapping

61
Q

What’s the most specific US sign for arterial dissection?

A

Double lumen sign

62
Q

What’s the difference between a aneurysm and a pseudoaneurysm?

A

A- when walls are intact but stretched
PSA- vascular mass that results from a hole in the arterial wall with circulating blood flow, confined by soft tissue and hematoma

63
Q

Pseudoaneurysms present patients with

A

Palpable pulsatile mass

64
Q

What are the causes of CCA PSA?

A

Blunt trauma
Infection/vasculitis
Iatrogenic

65
Q

What are the causes of an ICA PSA?

A

Trauma
Head/neck surgeries
Metastatic lymph nodes

66
Q

What’s a fistula?

A

Opening that connects two epithelialized structures

Usually occurs from trauma

67
Q

What is the most common arterial injury? (iatrogenic)

A

Carotid artery puncture.. usually leads to PSA and fistulas

68
Q

What is a Doppler sign for AVF?

A

Aliasing –arterial and venous flow simultaneously

69
Q

Flow proximal to the AVF will have what waveform?

A

Mono

70
Q

Flow in the injured artery, distal to the AVF will show what?

A

Normal flow

71
Q

Flow within the vein will appear (AVM)

A

Arterialized – lack of phasicity

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