Extracranial Cerebrovascular Pathology

Question 0

Describe plaque of atherosclerotic disease

Answer 0

Location

Surface characteristics - smooth vs irregular

Echogenicity - homogeneous, heterogeneous, calcification
(low, moderate, strong)

Question 1

describe atherosclerosis

Answer 1

thickening
hardening
loss of elasticity

Question 2

name the 6 types/forms of plaque

Answer 2

plaque
accumulations
lipid complex carbohydrates
fibrous tissue
calcium
fibrin

Question 3

describe fatty streak plaque

Answer 3

thin layer of lipid material
homogeneous
low level echoes

Question 4

describe fibrous plaque

Answer 4

homogeneous
low to medium echoes
accumulation of lipid and other

Question 5

describe complicated lesion plaque

Answer 5

fibrous with collagen and debris
heterogeneous
bright echoes with shadow

Question 6

describe ulcerative lesion plaque

Answer 6

deterioration of the surface

may result in embolization - breaking off

Question 7

what plays a role in plaque

Answer 7

inflammation

Question 8

plaque has a ______ matrix because lipids are ingested by ______

Answer 8

fibrous

macrophages

Question 9

define plaque

Answer 9

echogenic material that encroaches on the arterial lumen

Question 10

uncomplicated or stable plaque is ______

Answer 10

uniform

Question 11

complicated plaque is _____ _____ and has _______

Answer 11

not uniform

ulcerations

Question 12

what is embolism

Answer 12

piece of thrombus that moves until it lodges in a blood vessel

Question 13

what is an aneurysm

Answer 13

abnormal localized dilatation - rare in the cervical carotid

Question 14

what are 2 types of nonatherosclerotic disease

Answer 14

arteritis

Takayasu’s

Question 15

what is Takayasu’s

Answer 15

chronic inflammation that results in narrowing of arteries

Question 16

describe degree of stenosis

Answer 16

elevated velocity through the narrowed segment
color changes
post stenotic disturbances
turbulent blood flow
spectrul broadening

Question 17

Important to differentiate a stenosis from an ______

Answer 17

occlusion

Question 18

how do you rule out any trickle of flow

Answer 18

doppler
color doppler
power doppler
decrease color PRF
adjust sample volume

Question 19

describe an ICA occlusion - secondary characteristics

Answer 19

echogenic material filling the lumen
lack of arterial pulsations
reversed blood flow
loss of diastolic flow in CCA
increase velocity in ECA
increased velcity in contra ICA

Question 20

describe a stenosis

Answer 20

increased velocity - peak systolic velocity, end diastolic velocity, systolic velocity ratio

Question 21

what is the criteria for a stenosis

important

Answer 21

Stenosis chance PSV EDV
< 50% < 125 cm/sec n/a
50-79% >/= 125 cm/sec n/a
80-99% >/= 125 cm/sec >/= 140 cm/sec

Question 22

describe a critical stenosis

Answer 22

pressure and flow volume descrease

Question 23

what does a degree of abnormality depend on when dealing with a critical stenosis

Answer 23

length of narrowing
diameter of narrowing
pressure
resistance
collateral

Question 24

describe the 3 things in a stenosis profile

Answer 24

prox to stenosis, flow is dampened and pulsatility increases at the stenosis, increase velocities and spectral broadening post stenotic, flow reversals, disturbed flow

Question 25

stenosis: _____ pitched sound _____ velocities _____ broadening _____ to a stenosis - turbulent (dampeded/more round)

Answer 25

higher higher spectral distal

Question 26

the highest velocity obtained from and ICA stenosis is used to classify what

Answer 26

degree of narrowing

Question 27

doppler signals obtained distal to the area of poststenotic flow disturbance may be _____ or _____, and the upstroke of the distal doppler spectral waveform may be _____

Answer 27

normal or diminished slowed

Question 28

stenosis usually happen where

Answer 28

distally

Question 29

stenosis are _____ and systolic peak is _____

Answer 29

dampened rounded

Question 30

stenosis have a ______ ______ - delay arrival of systolic peak with low velocity

Answer 30

Tardus parvus

Question 31

An ICA occlusion is not amenable to _______ intervention

Answer 31

surgical

Question 32

To characterize an ICA as occluded, the artery should be evaluated with what

Answer 32

doppler, color doppler, and power doppler to rule out the presence of trickle flow

Question 33

when determining if the ICA is occluded, the color PRF should be ______ to document the presence of any slow moving blood flow and the color gain should be ______ to enchance any blood flow that may be present

Answer 33

decreased increased

Question 34

how is a residual lumen/trickle flow seen sonographically

Answer 34

the "string sign" using power doppler

Question 35

what surgery is done for plaque removal

Answer 35

thrombo endarterectomy

Question 36

Flow compensation: internalized ECA - indicates _______ high grade stenosis of ECA - _____ flow elevated high grade stenosis of ICA - _____ demonstrates higher resistance flow

Answer 36

disease - CCA occlusion ICA CCA

Question 37

turbulent flow is caused by what

Answer 37

stenosis kinking tortuosity increase in vessel diameter

Question 38

describe vertebral artery

Answer 38

branches of the subclavian arteries asymmetrical unite to form basilar artery long CCA - angle posterolaterally toward the back of neck wide variation in velocities direction of flow reversal of flow = subclavian steal --> obstruction in subclavian artery on same side

Question 39

describe subclavian steal

Answer 39

reversed flow in vertebral artery monophasic flow dampened more often on left side deceleration with late systolic velocities

Question 40

describe subclavain artery

Answer 40

multiphasic high resistance doppler blood pressure difference of greater than 20 mmHG is associated with disease in the side of the lower pressure

Question 41

what needs to be interpreted with a carotid exam

Answer 41

``` location of stenosis extent of plaque patency of distal ICA presence of tortuosity characteristics of plaque ```

Question 42

2 types of error interpretations

Answer 42

technique - positioning equipment settings

Question 43

Placement of sample volume must be _______ to the vessel wall

Answer 43

parallel

Question 44

sample volume should be kept ______

Answer 44

small

Question 45

sample volume in the ______ of the vessel

Answer 45

center

Question 46

angle of _____ degrees or less must be used for doppler

Answer 46

60

Question 47

describe 5 things about aneurysms

Answer 47

``` uncommon pulsatile neck masss bruit weakness of the media blood swirling ```

Question 48

describe CCA aneurysms

Answer 48

tortuous significant increase in vessel diameter abn blood flow pattern

Question 49

describe a dissection

Answer 49

``` blunt and penetrating trauma cervial injuries neck flexion associated with Marfan's syndrome between intima & medial layers creating a false lumen ```

Question 50

dissections can be caused by ______

Answer 50

trauma

Question 51

desribe dissection appearance

Answer 51

blood tears through the intima into the media different flow in lumen luminal narrowing

Question 52

describe fibromuscular dysplasia (FMD)

Answer 52

``` non atherosclerotic unknown etiology affects the media of the arterial wall mid segment of the ICA bilateral in 65% usually in females ```

Question 53

FMD gold standard is

Answer 53

angiography - "string of pearls" turbulent flow and absence of plaque

Question 54

what is the carotid body

Answer 54

small mass of vascular tissue that adjoins the carotid sinuses ovoid - 1 mm in size located in adventitia - posterior aspect of CCA bifurcation component of autonomic nervous system

Question 55

carotid body assists in regulating ______, ______, and ______

Answer 55

heart rate blood pressure respiration

Question 56

describe carotid body tumors

Answer 56

rare hypervascular structure that usually lies between the ICA and ECA ECA branch supplies blood to the tumor slow growing neoplasms

Question 57

clinical symptoms of a carotid body tumor

Answer 57

palpable neck mass | headache

Question 58

after a endarterectomy the ______ layer is missing because of removal

Answer 58

intima

Question 59

_____ _____ _____ is a technique that has been introduced as an alternative to carotid endarterectomy in selected patients

Answer 59

carotid artery stenting

Question 60

the gray scale image of a stent produces ______ echos

Answer 60

bright

Question 61

review protocol...

Answer 61

slide 224