Vascular Disease

Question 1

What is the adult prevalence of intracranial aneurysms?

Answer 1

2%

Question 2

What is the mortality rate of ruptured aneurysms?

Answer 2

30-40%

Question 3

What percent of ruptured aneurysms develop hydrocephalus?

Answer 3

15-20%

Question 4

What percent of ruptured aneurysms develop cardiac issues?

Answer 4

50%

Question 5

Summarize the rupture risk for aneurysm size based on the International Study of Unruptured Intracranial aneurysms? What kind of study was it?

Answer 5

prospective cohort

Question 6

What is the associated between Hunt Hess and clincal outcomes? Vasospasm?

Answer 6

Question 7

What is the World Federation of Neurosurgery grading scale?

Answer 7

Question 8

What is the modified fisher grade and what is the association with vasospasm?

Answer 8

Question 9

What percent of bacterial endocarditis patients have mycotic aneurysms?

Answer 9

5-15%

Question 10

What were the conclusions of the Internation Subarachnoid Aneurysm Trial (ISAT)?

Answer 10

Initially, large difference in mortality favoring coiling over clipping at 1 year. At 5-year follow-up, no difference in mortality between the two groups, though the incidence of rebleeding and aneurysm recurrence was higher in the coiling group

Question 11

What were the conclusions of the Barrow Ruptured Aneurysm Trial?

Answer 11

initial results at 1 year favoring coiling with regard to poor outcome. At 3-year follow-up, no difference between groups. The rate of recurrence, rebleeding, and aneurysm obliteration were better in the clipping group

Question 12

What are the general morbidity and mortality for coiling and clipping aneurysms?

Answer 12

mortality (1–2% for surgery/
coiling) and morbidity (4% coiling and 8% surgery)

Question 13

What is the Spetzler Martin grading system?

Answer 13

Question 14

What are the outcomes for AVMs based on Spetzler Martin grade? Explain in terms of morbidity with surgery, radiosurgery, and obliteration percent.

Answer 14

Question 15

What is the hemorrhage rate for AVMs?

Answer 15

2-4% per year, 6–18% in first year following initial hemorrhage if not treated. Lifetime risk of hemorrhage is 17–90%.

Question 16

What is the mortality of AVM hemorrhage?

Answer 16

mortality 10–30%, morbidity 10–30%.

Question 17

What are dural AVFs?

Answer 17

Pathological shunts between meningeal or extracranial arteries and the dural venous sinus, dural veins, or cortical veins

Question 18

What is the Borden classification for dAVFs?

Answer 18

Borden I: Generally benign (conversion rate to higher grade ~ 2%), but occasionally symptoms warrant treatment.

Borden II: Hemorrhage in 18%, annual hemorrhage rate of 6%.

Borden III: Present with hemorrhage in 34%, annual hemorrhage rate of 10% which increases to 21% with venous ectasia.

Question 19

What endovascular treatment is preferred for dAVF?

Answer 19

transvenous coiling

Question 20

What is the Cognard classifcation system?

Answer 20

Question 21

Moyamoya in asian adults usually causes _____ while in children usually _____. In American adults, it usually presents as ____.

Answer 21

hemorrhage

ischemia

ischemia

Question 22

What is the difference between moyamoya disease and syndrome?

Answer 22

disease: idiopathic
syndrome: secondary

Question 23

What is the grading system for moyamoya disease on angiography? What does it consist of?

Answer 23

Question 24

What is the risk of hemorrhage in cav mals?

Answer 24

Risk of symptomatic hemorrhage 0.5–2% per year, may be higher in patients with previous hemorrhages (~5% per year), deep lesions (~10% per year), posterior fossa lesions, familial inheritance, and women (~4% per year)

Question 25

What does the ICH score predict? What are those values?

Answer 25

mortality at 30 days

ICH score

0: 0%

1: 13%
2: 26%

3: 72%
4: 97%
5: 100%
6: 100%.

Question 26

What were the conclusions fo the STICH I and II trials?

Answer 26

supratentorial ICH surgical evacuation only mild benefit in long term mortality

Question 27

What were the conclusions of the MISTIE trial?

Answer 27

minimally invasive clot aspiration + tPA: 50% reduction in clot burden and at 6 and 12 months increase in number of patients in mRS 0–3 category versus mRS 4 and above

Question 28

What were the results of the CLEAR trial?

Answer 28

clot lysis of IVH with tPA through external ventricular drain (EVD): mortality rate of 18% in treatment group vs 23% in placebo group, similar ventriculitis rates ~8–9%

Question 29

Malignant cerebral edema presents in what percent of MCA infarcts?

Answer 29

10%

Question 30

What is the prevalence of carotid stenosis in the population?

Answer 30

2.5% for age < 65, 35% for age > 75

Question 31

Summarize the literature on carotid stenosis management, medically vs surgically.

Answer 31

Question 32

What percent fo CCFs are from trauma?

Answer 32

70%

Question 33

What are the types of CCFs?

Answer 33

direct (carotid artery)

indirect (adjacent branch)

Question 34

What is the presentation for CCFs?

Answer 34

Direct: orbital/retro-orbital pain, chemosis, pulsatile proptosis, ocular/cranial bruit, visual deterioration, diplopia, and ophthalmoplegia.

Indirect: more insidious onset. Conjunctival injection is most prominent feature

Question 35

What is the management of low flow CCFs?

Answer 35

can be watched until they spontaneously thrombose if visual acuity stable and intraocular pressure < 25 mm Hg. Can also perform daily manual compression of cervical ICA