Cerebrovascular disease Flashcards
What is patho cause of cerebrovascular disease?
Caused by atheroma in the carotid artery - namely the bifurcation
What can these people present with?
Stroke
TIA
Amaurosis
What is amaurosis?
Transient blindness in ipsilateral eye
How many strokes is cerebrovascular disease the cause of?
1 in 6 (15%)
Does the loudness of a bruit relate to severity?
No!
How do we investigate cerebrovascular disease?
Duplex scan (doppler carotid)
Angiography if uncertain
MRI/CT scan can back up findings
How do we treat symptomatic carotid disease?
Surgery:
Carotid endarterectomy
What is the absolute indication for surgery?
Symptomatic in past 6 months
70% stenosis in ICA
Fit for surgery
More than 2yr life expectancy
What is NNT?
The number needed to treat to prevent something happening in a patient
What is NNT for carotid endoarterectomy?
15
What is a endarterectomy?
Remove the diseased surface of the artery and repair with a patch so it isn’t weaker
What are the indications for stenting?
Patients who are unfit for surgery
Radiotherapy
Previous neck surgery
How do we treat asymptomatic disease?
Medical therapy
No real evidence for surgical benefit and has 50 NNT
What are the operative risks of endarterectomy?
Stroke 2.6%
Death 2%
Nerve injury 1%
