Week 3

Question 1

Which modality is the gold standard for preoperative assessment of patients for carotid intervention

Answer 1

Arteriography

Question 2

What other modalities are used for cerebrovascular disease

Answer 2

Plain CT
Contrast arteriography
MRA
CTA
Digital subtraction CTA

Question 3

What does non-invasive mean

Answer 3

No contrast agents

No catheter related complications

Question 4

What is arteriography used for

Answer 4

Catheter based technique
Stroke/death rate 0.2%-0.7%

This does not answer the question..oops

Question 5

What do we assess with arteriography

Answer 5

Aortic arch, SCA, and carotids (int and ext)

Question 6

Plain CT

Answer 6

Provides 2 and 3 dimensional images to identify silent infarcts, determining the timing of surgery, evaluating the risk of surgery, and r/o other causes of disease or symptoms

Question 7

What is CTA good for

Answer 7

Highlights the cerebrovascularity

Invasive –uses contrast

Question 8

What method visualizes the entire cerebral arterial system

Answer 8

Digital subtraction

Question 9

Is MRA preferred over duplex and angiography?

Answer 9

No

Question 10

What is the downside for MRA

Answer 10

It can overestimate the extent of the disease in turbulent flow areas

Question 11

Is MRA invasive?

Answer 11

No

Question 12

Angioplasty

Answer 12

Technique of mechanically widening narrowed or obstructed arteries
Usually because of arteriosclerosis

Question 13

What is the process for an angioplasty

Answer 13

Empty and collapsed ballon on a guide wire (balloon catheter) is put into the narrow location
Inflated using water pressure to 75-500x normal
Balloon expansion of inner plaque and muscle wall
Balloon is then deflated and removed, and a stent may or may not be inserted at this time

Question 14

What happens to the Doppler signals post stenting?

Answer 14

Alteration in biochemical properties
Can cause increase in velocities
Turbulence can be expected

Question 15

Is an abrupt increase in PSV normal ?

Answer 15

No–should be gradual

Question 16

PSV can increase throughout the patent area up to

Answer 16

150cm/s

Question 17

A velocity increase across the stent at a __:___ ratio identifies a degree of _______

Answer 17

2:1, restenosis

Question 18

Why is the stent assessed after the procedure?

Answer 18

To look for intimal thickening, restenosis, or plaque/thrombus formation

Question 19

What’s the criteria for CEA (endarectomy) and CAS (stenting)?

Answer 19

Symptomatic- 50-99%

Asymptomatic- 60-99%

Question 20

The risk of stroke/death in asymptomatic patients for a procedure must be

Answer 20

< 3%

Question 21

When should CAS be done in asymptomatic patients?

Answer 21

When they’re at high risk for intervention or with a life expectancy of < 3yrs

Question 22

What’s the grading criteria of those with a 50-69% stenosis?

Answer 22

PSV >125cm/s
EDV <110cm/s
Ratio >2 <4

Question 23

What’s the grading criteria of those with a 70-79% stenosis?

Answer 23

PSV >270 cm/s
EDV >110 cm/s
Ratio >4

Question 24

What’s the most important thing that should be ruled out following revascularization?

Answer 24

Restenosis

Question 25

PSV ratio measurements are taken

Answer 25

Pre and during stenosis

Question 26

What are the complications associated with CEA: | RRODHIPI (acronym)

Answer 26

``` Intimal flap Dissection Residual plaque at the end of CEA site Occlusion Infected patch Hematoma Pseudoaneursym Restenosis ```

Question 27

What Doppler (C and P) signs will you see with a PSA?

Answer 27

Yin Yang | To-and-fro

Question 28

What does coarctation mean

Answer 28

Narrowing

Question 29

Where is aortic coarctation most common?

Answer 29

Aortic arch-- usually where the ductus arteriosus inserts | Can be pre or post ductal

Question 30

What amount in pressure difference can be used to assess efficacy of surgical intervention?

Answer 30

70mm/Hg

Question 31

Patients with coarctation of the thoracic aorta may not have claudication and little/no change in ankle pressure following exercise. True or false

Answer 31

True--because of collaterals

Question 32

What's the treatment for coarctation?

Answer 32

Angioplasty or end-to-end anastomosis (removes narrowed portion)

Question 33

What are common causes of stroke?

Answer 33

Atrial fibrillation Hardening of arteries High BP

Question 34

What are the less common causes of stroke

Answer 34

Vasospasm FMD Radiation induced vasculopathy

Question 35

Ischemic stroke

Answer 35

Occur as a result of an obstruction within a blood vessel supplying blood to brain

Question 36

What's the underlying condition of ischemic stroke?

Answer 36

Arteriosclerosis

Question 37

What are the 2 types of obstruction that can occur with ischemic strokes?

Answer 37

Cerebral thrombus | Cerebral embolism

Question 38

Cerebral thrombosis:

Answer 38

refers to a thrombus that develops at the clogged part of the vessel in the brain (from arteriosclerosis)

Question 39

Where is a cerebral embolism typically from?

Answer 39

Heart or large arteries--such as carotids

Question 40

Vasospasm causes

Answer 40

Restriction in blood flow

Question 41

Cerebral (brain) vasospasm may happen after an operation for a bleed that occurs between the brain and the thin tissue covering the brain (subarachnoid hemorrhage). Vasospasm typically occur ________ days after subarachnoid hemorrhage.

Answer 41

4-10

Question 42

AVM:

Answer 42

Tangle of blood vessels where blood bypasses the tissue and goes straight from arteries to veins

Question 43

AVM's are more common in

Answer 43

Men

Question 44

Over 15 years, the total chance of an AVM bleeding into the brain, causing damage and stroke is

Answer 44

25%

Question 45

AVM's cause patients to experience what?

Answer 45

Localized pain in head due to increased blood flow

Question 46

Cerebral aneurysm is

Answer 46

Weak or thin spot on a blood vessel in the brain that balloons and fills with blood. This can put pressure on a nerve or surrounding tissue

Question 47

Brain aneurysms only occur in those over 40. True or false

Answer 47

False, can occur at any age | also mostly women

Question 48

Cerebral aneurysm most commonly occur in people 40-60years of age. True or false

Answer 48

False -- 30-60

Question 49

What are the risk factors of CA?

Answer 49

Hypertension Alcohol abuse Drug Abuse--cocaaaine Smoking cagrettes

Question 50

More commonly, cerebral aneurysm ruptures can cause a

Answer 50

Subarachnoid hemorrhage--space between bone and brain

Question 51

What is the most common type of arrhythmia?

Answer 51

Atrial fibrillation

Question 52

What is the significance of atrial fibrillation?

Answer 52

Blood pools in atria and is not completely pumped to ventricles. Stasis causing clotting, thrombus forms and embolism ensues

Question 53

CHF is treated with?

Answer 53

Anticoagulation therapy

Question 54

CHF is associated with thrombus formation and risk of stroke how?

Answer 54

Hypercoagulable state

Question 55

Which side of the heart is a thrombus more aggressive?

Answer 55

Right -- needs embollectomy or lytic therapy

Question 56

What is the most common cause of stroke in young adults?

Answer 56

Carotid artery dissection

Question 57

What are the 2 classes of CA dissection?

Answer 57

Spontaneous | Traumatic

Question 58

What may occur simultaneously as the dissection may be through the tunica adventia?

Answer 58

PSA

Question 59

What is treatment for carotid dissection?

Answer 59

Observation, anti-coagulation, stent implantation and carotid artery ligation

Question 60

Severe flow disturbances in a dissection are caused by

Answer 60

Intimal flapping

Question 61

What's the most specific US sign for arterial dissection?

Answer 61

Double lumen sign

Question 62

What's the difference between a aneurysm and a pseudoaneurysm?

Answer 62

A- when walls are intact but stretched PSA- vascular mass that results from a hole in the arterial wall with circulating blood flow, confined by soft tissue and hematoma

Question 63

Pseudoaneurysms present patients with

Answer 63

Palpable pulsatile mass

Question 64

What are the causes of CCA PSA?

Answer 64

Blunt trauma Infection/vasculitis Iatrogenic

Question 65

What are the causes of an ICA PSA?

Answer 65

Trauma Head/neck surgeries Metastatic lymph nodes

Question 66

What's a fistula?

Answer 66

Opening that connects two epithelialized structures | Usually occurs from trauma

Question 67

What is the most common arterial injury? (iatrogenic)

Answer 67

Carotid artery puncture.. usually leads to PSA and fistulas

Question 68

What is a Doppler sign for AVF?

Answer 68

Aliasing --arterial and venous flow simultaneously

Question 69

Flow proximal to the AVF will have what waveform?

Answer 69

Mono

Question 70

Flow in the injured artery, distal to the AVF will show what?

Answer 70

Normal flow

Question 71

Flow within the vein will appear (AVM)

Answer 71

Arterialized -- lack of phasicity