Carotid Artery Disease
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Questions and Answers

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?

  • Middle cerebral artery
  • Vertebral artery
  • Basilar artery
  • Anterior cerebral artery (correct)

    • 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?

    <p>Circle of Willis</p> Signup and view all the answers

    What are the common sites for cerebrovascular accidents (CVAs)?

    <p>Bifurcation of the common carotid</p> Signup and view all the answers

    What is the primary cause of amaurosis fugax?

    <p>Disruption of blood flow to the retina causing temporary loss of vision in one eye that is associated with carotid stenosis</p> Signup and view all the answers

    What is a key advantage of using general anesthesia during carotid endarterectomy (CEA)?

    <p>Enhanced patient tolerance and motionless surgical field</p> Signup and view all the answers

    What condition is characterized by miosis, ptosis, and anhidrosis?

    <p>Horner syndrome</p> Signup and view all the answers

    During carotid endarterectomy, once the carotid artery is clamped, cerebral perfusion relies on which flow?

    <p>Collateral flow from the circle of Willis</p> Signup and view all the answers

    Which of the following agents is considered a good option for induction in general anesthesia for CEA?

    <p>Propofol or etomidate</p> Signup and view all the answers

    Which of the following statements regarding the management of hypotension during carotid clamping is correct?

    <p>Neo is preferred for treating hypotension to maintain cerebral perfusion pressure.</p> Signup and view all the answers

    What is the recommended goal for blood pressure during carotid clamping?

    <p>10-20% above baseline</p> Signup and view all the answers

    Which volatile anesthetic is noted to provide the best protection against cerebral ischemia?

    <p>Isoflurane</p> Signup and view all the answers

    What is the appropriate action if local anesthetic infiltration at the surgical site does not effectively treat bradycardia?

    <p>Administer atropine.</p> Signup and view all the answers

    What is the main risk associated with the use of a shunt during carotid artery surgery?

    <p>Embolization.</p> Signup and view all the answers

    What is the primary purpose of monitoring activated clotting time (ACT) in surgical procedures involving heparin?

    <p>To monitor bleeding risk because PT and PTT are not clinically useful at high levels of heparin, which are often used during surgery</p> Signup and view all the answers

    What complication is commonly observed after carotid endarterectomy and associated with strokes?

    <p>Postoperative hypertension. Goal SBP&lt;180</p> Signup and view all the answers

    What potential disadvantage is associated with using regional anesthesia for carotid endarterectomy?

    <p>Increased risk of phrenic nerve dysfunction.</p> Signup and view all the answers

    What is the main cause of carotid artery disease?

    <p>Atherosclerosis</p> Signup and view all the answers

    What is the duration range for symptoms during a transient ischemic attack (TIA)?

    <p>5 minutes to 24 hours</p> Signup and view all the answers

    Which symptom differentiates a stroke from a TIA?

    <p>Neurological deficits lasting more than 24 hours</p> Signup and view all the answers

    What is the primary risk associated with carotid endarterectomy?

    <p>Higher risk of perioperative myocardial infarction</p> Signup and view all the answers

    In what scenario is carotid artery angioplasty and stenting preferred over carotid endarterectomy?

    <p>Severe obesity with a high BMI</p> Signup and view all the answers

    Which of the following is considered a symptom of symptomatic carotid artery disease?

    <p>Symptoms with ischemia and may result in TIA or stroke</p> Signup and view all the answers

    What vascular structure follows after the Basilar artery in the posterior circulation?

    <p>Posterior cerebral arteries</p> Signup and view all the answers

    Which factors are likely to influence cerebral injury from carotid artery disease? select all that apply

    <p>Circle of Willis integrity and collateral circulation</p> Signup and view all the answers

    What is the primary vessel of the posterior cerebral circulation?

    <p>Vertebral artery</p> Signup and view all the answers

    Which part of the brain does the internal carotid artery supply?

    <p>Ipsilateral cerebral hemispheres</p> Signup and view all the answers

    What part of the brain does the basilar artery supply via the posterior circulation? (Select all that apply)

    <p>Cervical spinal cord</p> Signup and view all the answers

    What is the most common cause of carotid artery disease characterized by the accumulation of fatty deposits along the subintimal layer of the arteries?

    <p>Atherosclerosis</p> Signup and view all the answers

    What is the proper order of the arteries in the anterior circulation?

    <p>Common carotid -&gt; Internal carotid -&gt; ACA and MCA -&gt; Anterior communicating artery</p> Signup and view all the answers

    What is the proper order of the arteries in the posterior circulation?

    <p>Vertebral arteries -&gt; Basilar artery -&gt; Posterior Cerebral Arteries -&gt; Posterior Communicating Arteries</p> Signup and view all the answers

    What can a Transient Ischemic Attack (TIA) indicate for future prognosis?

    <p>Increased risk of future stroke</p> Signup and view all the answers

    What differentiates a cerebrovascular accident (CVA) from a transient ischemic attack (TIA)?

    <p>Symptoms last longer than 24 hours</p> Signup and view all the answers

    What is the goal blood pressure during a carotid endarterectomy?

    <p>Slightly hypertensive to maintain cerebral perfusion pressure (CPP)</p> Signup and view all the answers

    Under what conditions would a carotid endarterectomy (CEA) be better than a carotid angioplasty stent (CAS)? (Select all that apply)

    <p>Aortic arch anatomical dysfunction</p> Signup and view all the answers

    Under what conditions would carotid angioplasty stent (CAS) be preferred over carotid endarterectomy (CEA)? Select all that apply

    <p>Severe obesity, COPD</p> Signup and view all the answers

    Which surgical procedure to treat carotid stenosis is a better, less invasive option for patients with multiple comorbidities?

    <p>Carotid Artery Angioplasty and Stenting</p> Signup and view all the answers

    What type of anesthesia is typically performed for carotid artery stenting?

    <p>Local anesthesia with light or no sedation</p> Signup and view all the answers

    What type of anesthesia is commonly used for carotid endarterectomy? select 2

    <p>General anesthesia</p> Signup and view all the answers

    What approach to carotid stenosis has a lower risk of myocardial infarction (MI) but a higher risk of stroke in patients older than 70?

    <p>Carotid artery stenting</p> Signup and view all the answers

    Which cranial nerve palsy results in abnormal laryngeal muscle movement due to injury to the superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN)?

    <p>Vagus nerve</p> Signup and view all the answers

    What is a benefit of general anesthesia for carotid artery endarterectomy (CAE)? select 3

    <p>Ischemic preconditioning</p> Signup and view all the answers

    Which hemodynamic parameter plays the most significant role in maintaining cerebral perfusion pressure (CPP) during carotid artery endarterectomy (CAE)?

    <p>Mean Arterial Pressure (MAP) because ICP shouldn't change much</p> Signup and view all the answers

    What is the range of CO2 levels in which it is directly proportional to cerebral blood flow (CBF)?

    <p>20-80 mmHg</p> Signup and view all the answers

    Why do we maintain blood pressure at normal limits or slightly hypertensive during cross-clamping?

    <p>Blood vessels in ischemic regions of the brain are maximally vasodilated and therefore pressure dependent</p> Signup and view all the answers

    What is impaired during cross-clamping regarding cerebral blood flow (CBF) response to changes in PaCO2?

    <p>Decreased CBF response</p> Signup and view all the answers

    What does the carotid stump pressure assess?

    <p>Perfusion pressure in the operative carotid artery</p> Signup and view all the answers

    What does the transcranial Doppler assess?

    <p>Blood flow velocity in the middle cerebral artery</p> Signup and view all the answers

    What is a risk of a surgeon forgoing the shunt during a carotid endarterectomy (CAE)?

    <p>Cerebral hypoxemia</p> Signup and view all the answers

    What condition is associated with an increased risk of stroke and death on the day of carotid artery endarterectomy (CAE)?

    <p>Hyperglycemia &gt;200 mg/dL</p> Signup and view all the answers

    What should be avoided preoperatively in a carotid artery endarterectomy (CAE)?

    <p>Sedatives</p> Signup and view all the answers

    When is heparin (50-100 units/kg) administered in a carotid artery endarterectomy (CAE)?

    <p>Before occlusion/clamping of the carotid artery</p> Signup and view all the answers

    What is the goal ACT in a CAE?

    <blockquote> <p>250 seconds</p> </blockquote> Signup and view all the answers

    What is a higher Activated Clotting Time (ACT) associated with?

    <p>Increased risk of bleeding</p> Signup and view all the answers

    What is used to reverse heparin and is also associated with hypotension and anaphylaxis?

    <p>Protamine</p> Signup and view all the answers

    Where do the vertebral arteries arise from?

    <p>Subclavian artery</p> Signup and view all the answers

    Where does the right carotid artery arise from?

    <p>Brachiocephalic artery</p> Signup and view all the answers

    What are two immediate considerations for emergence after a CES under general anesthesia?

    <p>Smooth emergence with no bucking</p> Signup and view all the answers

    What are the disadvantages of carotid artery endarterectomy (CAE) under regional anesthesia? (Select all that apply)

    <p>Conversion to general anesthesia (2-6%)</p> Signup and view all the answers

    What are the symptoms of the most common cranial nerve palsy resulting from carotid artery disease? Select the correct symptom.

    <p>Deviated tongue towards the site of injury due to hypoglossal injury</p> Signup and view all the answers

    What is Horner's syndrome?

    <p>A neurological condition resulting from disruption of the sympathetic pathways that innervate structures in the face and eye.</p> Signup and view all the answers

    What is cerebral hyperperfusion syndrome?

    <p>A condition characterized by increased blood flow to the brain due to impaired cerebral autoregulation following relief of high-grade stenosis</p> Signup and view all the answers

    What is one treatment for cerebral hyperperfusion syndrome?

    <p>Control hypertension (HTN)</p> Signup and view all the answers

    What is a complication associated with carotid artery stenting (CAS)? select 2

    <p>Balloon inflation in the internal carotid artery causing bradycardia and hypotension</p> Signup and view all the answers

    What type of imaging is used to differentiate an ischemic from a hemorrhagic stroke?

    <p>Non-contrast CT</p> Signup and view all the answers

    A pt postoperative from an ischemic stroke is NOT a candidate for thrombolytics

    <p>True</p> Signup and view all the answers

    When is succinylcholine contraindicated in the management of a patient with a stroke?

    <p>If the stroke occurred more than 24 hours prior to anesthesia</p> Signup and view all the answers

    When should blood pressure (BP) be treated in patients with an ischemic stroke?

    <p>All of the above</p> Signup and view all the answers

    What is the target for a cervical plexus block? select 2

    <p>Sensory branches of C2-C4</p> Signup and view all the answers

    Which technique provides better outcomes for carotid artery endarterectomy (CAE)?

    <p>Outcomes are the same regardless of the approach</p> Signup and view all the answers

    What complications are associated with a deep cervical plexus block? (Select all that apply)

    <p>Subarachnoid or epidural injection</p> Signup and view all the answers

    What are the expected outcomes of a deep cervical plexus block? (Select all that apply)

    <p>Phrenic nerve palsy affecting ipsilateral diaphragm movement in 60% of pts</p> Signup and view all the answers

    Which cranial nerve palsy is most commonly affected after CAE?

    <p>Hypoglossal nerve</p> Signup and view all the answers

    What is a common medical management option for carotid artery disease? (Select all that apply)

    <p>Antiplatelets</p> Signup and view all the answers

    When should patients with ischemic strokes receive tPA?

    <p>Within 4.5 hours of symptom onset</p> Signup and view all the answers

    When should patients with large vessel occlusion strokes receive an embolectomy?

    <p>Within 6 hours of onset of symptoms</p> Signup and view all the answers

    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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    Lesson 14 Carotid Artery Disease and Strokes PDF

    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.

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