Podcast
Questions and Answers
What is the primary vessel of the anterior circulation?
What is the primary vessel of the anterior circulation?
- Brachiocephalic artery
- Internal carotid artery (correct)
- Aorta
- Vertebral artery
Which artery supplies the medial surface of the cerebral hemisphere?
Which artery supplies the medial surface of the cerebral hemisphere?
- Middle cerebral artery
- Vertebral artery
- Basilar artery
- Anterior cerebral artery (correct)
From which artery does the left common carotid arise?
From which artery does the left common carotid arise?
- Subclavian artery
- Aorta (correct)
- Internal carotid artery
- Brachiocephalic artery
Which structure marks the convergence of anterior and posterior circulations?
Which structure marks the convergence of anterior and posterior circulations?
What are the common sites for cerebrovascular accidents (CVAs)?
What are the common sites for cerebrovascular accidents (CVAs)?
What is the primary cause of amaurosis fugax?
What is the primary cause of amaurosis fugax?
What is a key advantage of using general anesthesia during carotid endarterectomy (CEA)?
What is a key advantage of using general anesthesia during carotid endarterectomy (CEA)?
What condition is characterized by miosis, ptosis, and anhidrosis?
What condition is characterized by miosis, ptosis, and anhidrosis?
During carotid endarterectomy, once the carotid artery is clamped, cerebral perfusion relies on which flow?
During carotid endarterectomy, once the carotid artery is clamped, cerebral perfusion relies on which flow?
Which of the following agents is considered a good option for induction in general anesthesia for CEA?
Which of the following agents is considered a good option for induction in general anesthesia for CEA?
Which of the following statements regarding the management of hypotension during carotid clamping is correct?
Which of the following statements regarding the management of hypotension during carotid clamping is correct?
What is the recommended goal for blood pressure during carotid clamping?
What is the recommended goal for blood pressure during carotid clamping?
Which volatile anesthetic is noted to provide the best protection against cerebral ischemia?
Which volatile anesthetic is noted to provide the best protection against cerebral ischemia?
What is the appropriate action if local anesthetic infiltration at the surgical site does not effectively treat bradycardia?
What is the appropriate action if local anesthetic infiltration at the surgical site does not effectively treat bradycardia?
What is the main risk associated with the use of a shunt during carotid artery surgery?
What is the main risk associated with the use of a shunt during carotid artery surgery?
What is the primary purpose of monitoring activated clotting time (ACT) in surgical procedures involving heparin?
What is the primary purpose of monitoring activated clotting time (ACT) in surgical procedures involving heparin?
What complication is commonly observed after carotid endarterectomy and associated with strokes?
What complication is commonly observed after carotid endarterectomy and associated with strokes?
What potential disadvantage is associated with using regional anesthesia for carotid endarterectomy?
What potential disadvantage is associated with using regional anesthesia for carotid endarterectomy?
What is the main cause of carotid artery disease?
What is the main cause of carotid artery disease?
What is the duration range for symptoms during a transient ischemic attack (TIA)?
What is the duration range for symptoms during a transient ischemic attack (TIA)?
Which symptom differentiates a stroke from a TIA?
Which symptom differentiates a stroke from a TIA?
What is the primary risk associated with carotid endarterectomy?
What is the primary risk associated with carotid endarterectomy?
In what scenario is carotid artery angioplasty and stenting preferred over carotid endarterectomy?
In what scenario is carotid artery angioplasty and stenting preferred over carotid endarterectomy?
Which of the following is considered a symptom of symptomatic carotid artery disease?
Which of the following is considered a symptom of symptomatic carotid artery disease?
What vascular structure follows after the Basilar artery in the posterior circulation?
What vascular structure follows after the Basilar artery in the posterior circulation?
Which factors are likely to influence cerebral injury from carotid artery disease? select all that apply
Which factors are likely to influence cerebral injury from carotid artery disease? select all that apply
What is the primary vessel of the posterior cerebral circulation?
What is the primary vessel of the posterior cerebral circulation?
Which part of the brain does the internal carotid artery supply?
Which part of the brain does the internal carotid artery supply?
What part of the brain does the basilar artery supply via the posterior circulation? (Select all that apply)
What part of the brain does the basilar artery supply via the posterior circulation? (Select all that apply)
What is the most common cause of carotid artery disease characterized by the accumulation of fatty deposits along the subintimal layer of the arteries?
What is the most common cause of carotid artery disease characterized by the accumulation of fatty deposits along the subintimal layer of the arteries?
What is the proper order of the arteries in the anterior circulation?
What is the proper order of the arteries in the anterior circulation?
What is the proper order of the arteries in the posterior circulation?
What is the proper order of the arteries in the posterior circulation?
What can a Transient Ischemic Attack (TIA) indicate for future prognosis?
What can a Transient Ischemic Attack (TIA) indicate for future prognosis?
What differentiates a cerebrovascular accident (CVA) from a transient ischemic attack (TIA)?
What differentiates a cerebrovascular accident (CVA) from a transient ischemic attack (TIA)?
What is the goal blood pressure during a carotid endarterectomy?
What is the goal blood pressure during a carotid endarterectomy?
Under what conditions would a carotid endarterectomy (CEA) be better than a carotid angioplasty stent (CAS)? (Select all that apply)
Under what conditions would a carotid endarterectomy (CEA) be better than a carotid angioplasty stent (CAS)? (Select all that apply)
Under what conditions would carotid angioplasty stent (CAS) be preferred over carotid endarterectomy (CEA)? Select all that apply
Under what conditions would carotid angioplasty stent (CAS) be preferred over carotid endarterectomy (CEA)? Select all that apply
Which surgical procedure to treat carotid stenosis is a better, less invasive option for patients with multiple comorbidities?
Which surgical procedure to treat carotid stenosis is a better, less invasive option for patients with multiple comorbidities?
What type of anesthesia is typically performed for carotid artery stenting?
What type of anesthesia is typically performed for carotid artery stenting?
What type of anesthesia is commonly used for carotid endarterectomy? select 2
What type of anesthesia is commonly used for carotid endarterectomy? select 2
What approach to carotid stenosis has a lower risk of myocardial infarction (MI) but a higher risk of stroke in patients older than 70?
What approach to carotid stenosis has a lower risk of myocardial infarction (MI) but a higher risk of stroke in patients older than 70?
Which cranial nerve palsy results in abnormal laryngeal muscle movement due to injury to the superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN)?
Which cranial nerve palsy results in abnormal laryngeal muscle movement due to injury to the superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN)?
What is a benefit of general anesthesia for carotid artery endarterectomy (CAE)? select 3
What is a benefit of general anesthesia for carotid artery endarterectomy (CAE)? select 3
Which hemodynamic parameter plays the most significant role in maintaining cerebral perfusion pressure (CPP) during carotid artery endarterectomy (CAE)?
Which hemodynamic parameter plays the most significant role in maintaining cerebral perfusion pressure (CPP) during carotid artery endarterectomy (CAE)?
What is the range of CO2 levels in which it is directly proportional to cerebral blood flow (CBF)?
What is the range of CO2 levels in which it is directly proportional to cerebral blood flow (CBF)?
Why do we maintain blood pressure at normal limits or slightly hypertensive during cross-clamping?
Why do we maintain blood pressure at normal limits or slightly hypertensive during cross-clamping?
What is impaired during cross-clamping regarding cerebral blood flow (CBF) response to changes in PaCO2?
What is impaired during cross-clamping regarding cerebral blood flow (CBF) response to changes in PaCO2?
What does the carotid stump pressure assess?
What does the carotid stump pressure assess?
What does the transcranial Doppler assess?
What does the transcranial Doppler assess?
What is a risk of a surgeon forgoing the shunt during a carotid endarterectomy (CAE)?
What is a risk of a surgeon forgoing the shunt during a carotid endarterectomy (CAE)?
What condition is associated with an increased risk of stroke and death on the day of carotid artery endarterectomy (CAE)?
What condition is associated with an increased risk of stroke and death on the day of carotid artery endarterectomy (CAE)?
What should be avoided preoperatively in a carotid artery endarterectomy (CAE)?
What should be avoided preoperatively in a carotid artery endarterectomy (CAE)?
When is heparin (50-100 units/kg) administered in a carotid artery endarterectomy (CAE)?
When is heparin (50-100 units/kg) administered in a carotid artery endarterectomy (CAE)?
What is the goal ACT in a CAE?
What is the goal ACT in a CAE?
What is a higher Activated Clotting Time (ACT) associated with?
What is a higher Activated Clotting Time (ACT) associated with?
What is used to reverse heparin and is also associated with hypotension and anaphylaxis?
What is used to reverse heparin and is also associated with hypotension and anaphylaxis?
Where do the vertebral arteries arise from?
Where do the vertebral arteries arise from?
Where does the right carotid artery arise from?
Where does the right carotid artery arise from?
What are two immediate considerations for emergence after a CES under general anesthesia?
What are two immediate considerations for emergence after a CES under general anesthesia?
What are the disadvantages of carotid artery endarterectomy (CAE) under regional anesthesia? (Select all that apply)
What are the disadvantages of carotid artery endarterectomy (CAE) under regional anesthesia? (Select all that apply)
What are the symptoms of the most common cranial nerve palsy resulting from carotid artery disease? Select the correct symptom.
What are the symptoms of the most common cranial nerve palsy resulting from carotid artery disease? Select the correct symptom.
What is Horner's syndrome?
What is Horner's syndrome?
What is cerebral hyperperfusion syndrome?
What is cerebral hyperperfusion syndrome?
What is one treatment for cerebral hyperperfusion syndrome?
What is one treatment for cerebral hyperperfusion syndrome?
What is a complication associated with carotid artery stenting (CAS)? select 2
What is a complication associated with carotid artery stenting (CAS)? select 2
What type of imaging is used to differentiate an ischemic from a hemorrhagic stroke?
What type of imaging is used to differentiate an ischemic from a hemorrhagic stroke?
A pt postoperative from an ischemic stroke is NOT a candidate for thrombolytics
A pt postoperative from an ischemic stroke is NOT a candidate for thrombolytics
When is succinylcholine contraindicated in the management of a patient with a stroke?
When is succinylcholine contraindicated in the management of a patient with a stroke?
When should blood pressure (BP) be treated in patients with an ischemic stroke?
When should blood pressure (BP) be treated in patients with an ischemic stroke?
What is the target for a cervical plexus block? select 2
What is the target for a cervical plexus block? select 2
Which technique provides better outcomes for carotid artery endarterectomy (CAE)?
Which technique provides better outcomes for carotid artery endarterectomy (CAE)?
What complications are associated with a deep cervical plexus block? (Select all that apply)
What complications are associated with a deep cervical plexus block? (Select all that apply)
What are the expected outcomes of a deep cervical plexus block? (Select all that apply)
What are the expected outcomes of a deep cervical plexus block? (Select all that apply)
Which cranial nerve palsy is most commonly affected after CAE?
Which cranial nerve palsy is most commonly affected after CAE?
What is a common medical management option for carotid artery disease? (Select all that apply)
What is a common medical management option for carotid artery disease? (Select all that apply)
When should patients with ischemic strokes receive tPA?
When should patients with ischemic strokes receive tPA?
When should patients with large vessel occlusion strokes receive an embolectomy?
When should patients with large vessel occlusion strokes receive an embolectomy?
Flashcards
Anterior Circulation Pathway
Anterior Circulation Pathway
Blood flow to the brain's front parts, primarily from the internal carotid artery.
Internal Carotid Artery Branches
Internal Carotid Artery Branches
Branches into anterior and middle cerebral arteries, supplying the brain's front and side.
Circle of Willis
Circle of Willis
A network of arteries that connects the anterior and posterior circulations, providing backup blood flow.
Posterior Circulation Pathway
Posterior Circulation Pathway
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Vertebral Artery Origin
Vertebral Artery Origin
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Communicating artery
Communicating artery
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Carotid artery disease
Carotid artery disease
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Ischemic stroke
Ischemic stroke
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Hemorrhagic stroke
Hemorrhagic stroke
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Transient Ischemic Attack (TIA)
Transient Ischemic Attack (TIA)
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Stroke risk factors
Stroke risk factors
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Atherosclerosis
Atherosclerosis
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TIA symptoms
TIA symptoms
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CVA
CVA
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Stroke in evolution
Stroke in evolution
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Carotid Endarterectomy (CEA)
Carotid Endarterectomy (CEA)
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Carotid Artery Angioplasty Stenting (CAS)
Carotid Artery Angioplasty Stenting (CAS)
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Carotid Stenosis
Carotid Stenosis
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Modifiable risk factors (Carotid Disease)
Modifiable risk factors (Carotid Disease)
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Preoperative Medication Optimization
Preoperative Medication Optimization
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Pts with high-grade stenosis (Carotid Disease)
Pts with high-grade stenosis (Carotid Disease)
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Amaurosis Fugax
Amaurosis Fugax
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Cranial Nerve Assessment
Cranial Nerve Assessment
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Regional vs. General Anesthesia
Regional vs. General Anesthesia
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Horner Syndrome
Horner Syndrome
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Cerebral Perfusion Pressure (CPP)
Cerebral Perfusion Pressure (CPP)
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Carotid Endarterectomy (CEA) under GA
Carotid Endarterectomy (CEA) under GA
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CEA: Perioperative Goals
CEA: Perioperative Goals
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CEA: Induction and Maintenance
CEA: Induction and Maintenance
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Nitroprusside Use
Nitroprusside Use
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Carotid Baroreceptor Manipulation
Carotid Baroreceptor Manipulation
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Atropine for Bradycardia
Atropine for Bradycardia
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Goal Blood Pressure During Clamping
Goal Blood Pressure During Clamping
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Isoflurane for Cerebral Ischemia
Isoflurane for Cerebral Ischemia
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Heparin Dosage for Carotid Endarterectomy
Heparin Dosage for Carotid Endarterectomy
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Activated Clotting Time (ACT)
Activated Clotting Time (ACT)
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Carotid Stump Pressure
Carotid Stump Pressure
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Study Notes
Anterior Circulation
- Anterior circulation supplies most of the brain's blood flow
- Internal carotid artery is the primary vessel
- Pathway: aorta → internal carotid → Circle of Willis → cerebral hemispheres
- Internal carotid arteries pass through the skull's foramen lacerum
- Bifurcate into anterior and middle cerebral arteries
- Anterior cerebral artery (ACA) supplies the medial surface of the brain
- Middle cerebral artery (MCA) supplies the lateral surface
- Striate arteries are common sites for cerebrovascular accidents (CVAs)
- Common carotid artery branches into the left and right common carotid arteries
- Left common carotid arises from the aorta
- Right common carotid arises from the brachiocephalic artery
- The external carotid artery supplies blood to the structures external to the brain
Posterior Circulation
- Posterior circulation supplies the brainstem, cerebellum, and posterior fossa structures
- Vertebral arteries arise from the subclavian artery
- Enter the skull through the foramen magnum
- Branches of the vertebral and basilar arteries supply the brainstem, cerebellum, vestibular apparatus, cochlear nuclei, and parts of temporal and occipital lobes
- Posterior circulation pathways: aorta → subclavian → vertebral → basilar → posterior fossa structures
- Anterior and posterior circulations converge at the Circle of Willis
Circle of Willis
- Anterior and posterior circulations converge at the Circle of Willis
- A circulatory anastomosis
- Helps equalize blood flow and maintain blood supply to the brain
Carotid Disease
- Atherosclerosis is the most common cause of carotid disease
- Fatty deposits accumulate in the subintimal layer of the arteries
- Plaque buildup causes narrowing and decreased blood flow
- Plaques can rupture and cause thrombi/emboli and stroke
- Two types of stroke: ischemic and hemorrhagic
- Ischemic stroke (80%) is most common, caused by embolism, thrombus, or vasospasm
- Hemorrhagic stroke (20%) is caused by a ruptured vessel
Carotid Risk Factors
- Older age, male sex, family history, high blood pressure (HTN), smoking, diabetes, obesity, and high cholesterol.
Carotid Artery Disease Symptoms
- Usually asymptomatic (plaques present, but adequate blood flow maintained)
- Symptomatic disease, plaques may cause ischemia symptoms, transient ischemic attack (TIA), or stroke
Transient Ischemic Attack (TIA)
- Sudden temporary loss of blood flow to an area of the brain
- Usually lasts 5 minutes to 24 hours
- Symptoms similar to stroke, but resolve completely within 24 hours
- Can be a warning sign for a future stroke
Stroke
- Neurological deficits persisting for more than 24 hours
- Complete or incomplete evolution
- Complete = entire area affected
- Incomplete = additional brain area remains at risk
Carotid Disease Treatments
- Medical Treatment: Medications (antiplatelets, anticoagulants, statins) to control risk factors
- Surgical Treatment: Endarterectomy (surgical removal of plaque), Angioplasty and Stenting (inserting a stent to widen the artery)
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Description
This quiz covers the concepts of anterior and posterior circulation in the human brain, detailing major vessels and their functions. It explores the pathways and supplies of blood flow to different regions, focusing on arteries involved in cerebrovascular incidents. Test your understanding of how blood circulates through the brain’s important structures.
