Stroke and Transient Ischemic Attack
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Questions and Answers

What is the approximate percentage of Transient Ischemic Attacks (TIAs) that last greater than 1 hour?

  • 5%
  • 25% (correct)
  • 50%
  • 10%

    • What is the percentage of strokes that are hemorrhagic?

  • 20%
  • 15% (correct)
  • 5%
  • 10%

    • What is the time frame within which half of the strokes occur after a Transient Ischemic Attack (TIA)?

  • 24 hours
  • 1 week
  • 48 hours (correct)
  • 3 months

    • What is the site of Extracranial atherosclerosis?

    <p>Carotid / Vertebral / Aortic Arch (D)</p> Signup and view all the answers

    What is the reported prevalence of prior TIA among those who present with a stroke?

    <p>7-40% (B)</p> Signup and view all the answers

    What is the time frame within which someone dies of a stroke in the United States?

    <p>Every 4 minutes (D)</p> Signup and view all the answers

    What is the definition of a Transient Ischemic Attack (TIA) based on tissue?

    <p>Brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction. (C)</p> Signup and view all the answers

    What percentage of TIAs will be followed by a stroke within 3 months?

    <p>10-20% (C)</p> Signup and view all the answers

    What percentage of individuals have a symmetrical Circle of Willis?

    <p>20% (A)</p> Signup and view all the answers

    What is the primary mechanism responsible for episodes of TIA/STROKE in carotid artery disease?

    <p>Cerebral emboli (A)</p> Signup and view all the answers

    What is the recommended treatment for hypertension in carotid artery disease management?

    <p>Treatment of hypertension (A)</p> Signup and view all the answers

    What is the goal of carotid interventions in carotid artery disease management?

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

    What is the recommended technique for carotid endarterectomy closure?

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

    What is the purpose of embolic protection filters in carotid stenting?

    <p>To prevent cerebral emboli (D)</p> Signup and view all the answers

    What is the difference between CEA and CAS in terms of 30-day stroke or death in symptomatic patients?

    <p>CEA is superior to CAS (C)</p> Signup and view all the answers

    What is the role of transcranial doppler in carotid endarterectomy?

    <p>To monitor for cerebral emboli (C)</p> Signup and view all the answers

    What is the most appropriate management strategy for a patient with a minor stroke and 70% stenosis of the left internal carotid artery, with a good 3-5 year life expectancy?

    <p>Carotid Endarterectomy of the left internal carotid artery (B)</p> Signup and view all the answers

    What is the significance of a 4/5 right-sided weakness in this patient?

    <p>It is a sign of a major stroke (C)</p> Signup and view all the answers

    What is the benefit of statin therapy in this patient?

    <p>It reduces the risk of stroke with best medical therapy (D)</p> Signup and view all the answers

    What is the role of biomarkers in carotid disease management?

    <p>They are used to identify carotid plaque vulnerability (D)</p> Signup and view all the answers

    What is the indication for Carotid Endarterectomy in this patient?

    <p>The patient has a minor stroke and 70% stenosis of the left internal carotid artery (B)</p> Signup and view all the answers

    What is the significance of a Left Carotid bruit in this patient?

    <p>It is a sign of carotid stenosis (A)</p> Signup and view all the answers

    What is the role of aspirin in this patient's management?

    <p>It is used to reduce the risk of stroke with best medical therapy (D)</p> Signup and view all the answers

    What is the benefit of Carotid Stenting in this patient?

    <p>It is a less invasive alternative to Carotid Endarterectomy (A)</p> Signup and view all the answers

    What is the consideration for patients with life expectancy exceeding 5 years?

    <p>CEA should be considered (A)</p> Signup and view all the answers

    What is the average annual risk of ipsilateral stroke in Asx >50% stenosis?

    <p>3.5% (D)</p> Signup and view all the answers

    What is the 5-year risk of carotid territory ischaemic stroke in patients 75+ years old?

    <p>8.79% (B)</p> Signup and view all the answers

    What is the difference in the 5-year risk of carotid territory ischaemic stroke between immediate and deferred treatment?

    <p>3.29% (CI -1.86-8.44) (A)</p> Signup and view all the answers

    What is the role of CAS in patients with Asx CAD >60%?

    <p>CAS is an alternative to CEA (C)</p> Signup and view all the answers

    What is the benefit of CAS in the elderly?

    <p>The benefit is questionable (C)</p> Signup and view all the answers

    What is the indication for considering CEA in patients with Asx CAD >60%?

    <p>Life expectancy exceeding 5 years (B)</p> Signup and view all the answers

    What is the presentation of the 67-year-old male in the case scenario?

    <p>Acute weakness of his right arm and leg (B)</p> Signup and view all the answers

    What is the primary consideration for technique selection in revascularization?

    <p>Stage of ischemia (D)</p> Signup and view all the answers

    What is the preferred choice of conduit in open surgery?

    <p>Autologous venous conduit (C)</p> Signup and view all the answers

    In which patients is open surgery likely better?

    <p>Low surgical risk patients with good life expectancy and a good quality saphenous vein conduit (B)</p> Signup and view all the answers

    What is the criterion for selecting endovascular techniques over open surgery?

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

    What is the advantage of covered self-expanding stents?

    <p>Highest patency rates (D)</p> Signup and view all the answers

    What is the primary goal of risk factor control in PAD treatment?

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

    What is the purpose of cilostazol in PAD treatment?

    <p>To improve exercise performance (C)</p> Signup and view all the answers

    What is the significance of Factor V Leiden in PAD treatment?

    <p>It increases the risk of thrombosis (B)</p> Signup and view all the answers

    Study Notes

    Cerebrovascular Event Classification

    • Transient Ischemic Attack (TIA):
      • No infarct (cell death)
      • Time-based definition: sudden, focal neurologic deficit lasting less than 24 hours
      • Tissue-based definition: brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, without evidence of acute infarction
    • Stroke (infarct = cell death)

    Transient Ischemic Attack Facts

    • 10-20% of TIAs will be followed by a stroke within 3 months, half of them within 48 hours
    • Among those who present with a stroke, the prevalence of prior TIA is reported to be 7-40%

    Stroke

    • Infarction of the central nervous system tissue related to hypoperfusion, embolization, thrombosis, or intracranial hemorrhage
    • Types:
      • Ischemic (85%)
      • Hemorrhagic (15%)

    Extracranial Atherosclerosis

    • Sites:
      • Carotid/Vertebral/Aortic Arch
    • Types:
      • Lacunar (small vessel)
      • Cardioembolic
      • Miscellaneous (e.g. hypercoagulability, cryptogenic)

    Carotid Artery Disease

    • Degree/progression of atherosclerotic stenosis
    • Plaque quality (stable vs unstable)
    • Embolization: primary mechanism responsible for TIA/STROKE
    • Vulnerable carotid plaque:
      • Unstable plaques are mainly associated with TIA/STROKE
      • Identifying vulnerable carotid plaque: clinical information, family history, genetics, imaging, and biological markers

    Take Away Messages

    • Amaurosis fugax, TIA, or minor stroke are typically a warning sign of a major stroke in the setting of carotid stenosis ≥50%
    • Imaging techniques and biomarkers can identify carotid plaque vulnerability
    • Risk of stroke with BMT is declining (statins, antiplatelets, antihypertensives, etc.)
    • Sx patients with >50% stenosis will benefit from an intervention to prevent a new stroke
    • Asx patients with >70% stenosis will benefit from an intervention (to prevent a stroke) provided they have a good 3-5 year life expectancy
    • Risk of perioperative stroke with intervention is also declining

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    Description

    This quiz covers the classification of cerebrovascular events, including transient ischemic attacks and strokes. Learn about the differences between these two conditions and their definitions.

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