Aneurysms 2 - carotid disease

Question 1

What is associated with Atherosclerosis of the carotid arteries

Answer 1

transient ischaemic attacks and ischaemic stroke

Question 2

What is the function of the carotid arteries

Answer 2

Carotid arteries are the blood vessels that carry oxygenated blood to the head, brain and face, located on each side of the neck

Question 3

What is the aetiology of cerebral infarction in the cause of a stroke

Answer 3

clot blocking arteries (plaque rupture/thrombosis)
endocarditis, 
MI, 
carotid artery trauma/dissection 
drug use, 
sickle cell haemotological disorders
Atrial fibrillation

Question 4

What is the aetiology of an ischaemic event

Answer 4

clot blocking arteries, endocarditis, MI, carotid artery trauma, drug use, sickle cell haemotological disorders

Question 5

What is the definition of Transient Ischaemic Attack

Answer 5

Focal CNS disturbance caused by vascular events such as microemboli and occlusion leading to cerebral ischaemia. Symptoms last less than 24 hours and there are no permanent neurological sequelae.

Question 6

What is the definition of stroke

Answer 6

Clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.

Question 7

What is the pathophysiology of a carotid disease

Answer 7

Original Atherosclerotic plaque forms which is at risk of rupture = thrombus
When thrombus dislodges, it causes TIAs/stroke

Question 8

Carotid disease is a systemic disease therefore what can it further cause

Answer 8

claudication, ulcers, stroke, etc

Question 9

What does the likelihood of a Atherosclerotic plaque rupturing in carotid disease dependant on

Answer 9

Virchow triad

Question 10

What is the diagnose of carotid artery atherosclerosis dependant on

Answer 10

History
Examination
CT
Carotid Ultrasound scan

Question 11

What does measuring the velocity of flow indicate in diagnosing carotid artery atherosclerosis

Answer 11

suspected stenosis

Question 12

What does a greater velocity indicate about the radius of the vessel

Answer 12

As radius of a vessel decreases (i.e. stenosis), velocity increases.

Question 13

How is brain still able to be perfused in a TIA or an occluded internal carotid artery

Answer 13

Brain is still perfused due to circle of willis

Question 14

What imposes the risk of further stroke occurring in a TIA or an occluded right internal carotid artery

Answer 14

emboli being showered from high velocity flow in a diseased carotid artery, causing distal ischaemia.
NO FLOW = NO EMBOLI

Question 15

What is the purpose of Carotid endaterectomy and how does it occur

Answer 15

PROPHYLACTIC - prevent disease occurring

an incision is made to open the carotid artery, plaque is removed, then the repaired artery is closed

Question 16

What is the general complications of Carotid endaterectomy

Answer 16

Wound infection, bleeding, scar, anaesthetic risks

Nerve damage: vagus, hypoglossal, glossopharyngeal giving hoarseness of the voice

Question 17

What is the nearby nerves that can be damaged in Carotid endaterectomy

Answer 17

vagus, hypoglossal, glossopharyngeal (giving hoarseness of the voice)

Question 18

How can the complication of Perioperative stroke occur

Answer 18

Plaque rupture sending clot further up
Hypoperfusion- circulatory shock
Virchow’s triad – raw intimal surface and thrombosis e.g. change in vessel wall

Question 19

What is an alternative medical therapy used in the treatment of carotid disease

Answer 19

stenting

Question 20

How does the procedure of stenting occur

Answer 20

Artery is cannulated by putting wire through and releasing a stent

Question 21

What is the concerns in stenting

Answer 21

Main concern is putting wire through initially

and not putting healthy artery above and below at risk

Question 22

What percentage of stenosis should surveillance and surgery be the management

Answer 22

Surveillance - Less than 50% stenosis

Surgery - Stenosis above 70%

Question 23

What therapy has higher risk of stroke and heart attack

Answer 23

Stroke - stenting

Heart attack - surgery

Question 24

When would you consider operating on asymptomatic patients

Answer 24

CEA should be considered for asymptomatic patients with high grade carotid stenosis >70%

Asymptomatic CEA should only be performed by operators with a low (<3%) perioperative stroke or death rate

Question 25

What is the riskiest period for further event

Answer 25

within the first two weeks