Vascular - Extracranial

Question 1

What is the survival rate for initial stroke?

What is the risk of recurrence?

Answer 1

• 80%
• Recurrence
  
  • 10% - first year
  • 20% - over 5 years

Question 2

What is the mortality rate of recurrent stroke?

Answer 2

60%

Question 3

What is the cause of 2/3 of ischemic strokes?

Answer 3

• Cerebrovascular disease
  
  • Hypoperfusion
  • Embolization

Question 4

What is the most common site of significant atherosclerosis which leads to ischemic stroke?

Answer 4

Carotid bifurcation

Question 5

What are the most common symptoms/presenations associated with vertebral artery disease?

Answer 5

• Ischemia symptoms –> from embolization
• Isolated stenosis –> may not be symptomatic
• Hemodynamic abnormalities –> due to proximal occlusive disease
  
  • steal syndrome vs. steal physiology

Question 6

What is the class I recommendation for:

• Low grade carotid stenosis
  
  • define
  • treatment

Answer 6

• Definition:
  
  • < 50% in symptomatic
  • < 60% in asymptomatic
• Treatment:
  
  • optimal medical therapy

Question 7

What is the class I recommendation for:

Moderate to severe stenosis (symptomatic)

• define
• treatment

Answer 7

• Definition
  
  • > 50% stenosis
• Treatment:
  
  • CEA + optimal medical therapy

Question 8

What is the class I recommendation for:

• Moderate to severe stenosis (asymptomatic)
  
  • define
  • treatment

Answer 8

• Definition
  
  • ► 60%
• Treatment
  
  • CEA + OMT ***(if perioperative risk is low)***

Question 9

What is the recommendation:

• Moderate to severe stenosis (symptomatic) + high perioperative risk
  
  • define
  • treatment

Answer 9

• Definition:
  
  • ► 50%
• Treatment:
  
  • Carotid artery stenting (CAS) as alternative to CEA

Question 10

Describe the branches

Answer 10

Question 11

Describe the vessel and branches

Answer 11

Question 12

How does the external carotid artery provide important intracranial flow in cases of severe ICA stenosis?

Answer 12

Opthalmic artery

Question 13

Describe the vessel and branches

Answer 13

Question 14

What does “fetal posterior communication artery” mean?

Answer 14

the posterior communicating atery is the major contributor to the posterior cerebral artery

Question 15

What deficits occur with infarction of the anterior cerebral artery?

Answer 15

• contralateral weakness of the leg and shoulder
• cortical sensory deficits (also common)

Question 16

Where does the anterior cerebral artery (ACA) join its contralateral counterpart to complete the circle of Willis?

Answer 16

at the anterior communicating artery

Question 17

Describe the segments of the anterior cerebral artery

Answer 17

• Proximal (A1 segment)
  
  • between the origin and the anterior communicating artery
• A2 segment
  
  • between anterior communicating artery and the rostrum of the corpus callosum
• Distal (pericallosal artery)
  
  • gives rise to numerous cortical branches
  • largest pericallosal branch = callosomarginal artery