Surgical Therapy: Carotid Artery Stenosis
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Surgical Therapy: Carotid Artery Stenosis

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Questions and Answers

What is the primary contributing factor to stroke associated with symptomatic carotid artery stenosis?

  • Proximal arterial occlusion
  • Low levels of vessel-wall shear stress
  • Atherosclerotic lesions in the carotid artery bifurcation (correct)
  • Increased blood pressure
  • Which patient demographic is most likely to benefit from carotid endarterectomy (CEA) according to research?

  • Patients with less than 50% stenosis
  • Patients with symptomatic stenosis of 50%-99% (correct)
  • Patients with mild asymptomatic carotid stenosis
  • Patients under 50 years with symptomatic stenosis
  • What role does plaque structure play in carotid artery stenosis?

  • It may influence the risk of stroke. (correct)
  • It has no impact on stroke risk.
  • It is the sole determinant of ischemic events.
  • It is less important than the degree of stenosis.
  • What percentage of ischemic strokes are attributed to extra-cranial internal carotid artery stenosis?

    <p>5%</p> Signup and view all the answers

    In which anatomical area does carotid atherosclerosis most commonly develop?

    <p>Carotid bulb</p> Signup and view all the answers

    Which of the following interventions is most critical in preventing aspiration in stroke patients?

    <p>Positioning the head of bed at least 30 degrees</p> Signup and view all the answers

    What is indicated for patients with evidence of oropharyngeal dysfunction?

    <p>Nothing by mouth until evaluated by a speech pathologist</p> Signup and view all the answers

    What is the recommended monitoring duration for cardiac function after a stroke?

    <p>48 hours</p> Signup and view all the answers

    What is the optimal range for arterial blood pressure in patients post-stroke?

    <p>160-200 mm Hg systolic</p> Signup and view all the answers

    What percentage range depicts the chance of concomitant cerebral and myocardial ischemia occurring together?

    <p>3%-20%</p> Signup and view all the answers

    In managing stroke patients, what condition should be initially avoided to prevent further complications?

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

    What should be done if ischemic ECG changes or abnormal cardiac troponin levels are observed?

    <p>Serial ECG and cardiac troponin monitoring</p> Signup and view all the answers

    What is often a critical step in the emergency care of a stroke patient?

    <p>Maintain an open airway</p> Signup and view all the answers

    Which complication has a mortality rate as high as 15%-25% in stroke patients?

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

    What should be prioritized during the first 48-72 hours post-stroke?

    <p>Blood pressure monitoring</p> Signup and view all the answers

    Study Notes

    Symptomatic Carotid Artery Stenosis

    • Atherosclerotic lesions at the carotid artery bifurcation are a common cause of stroke.
    • Approximately 5% of ischemic strokes are attributed to extra-cranial internal carotid artery stenosis.
    • Carotid atherosclerosis typically forms in regions with low vessel-wall shear stress, particularly at the carotid bulb.
    • The severity of carotid artery stenosis is important, but the structure of the plaque may also significantly influence stroke risk.

    Stroke Overview

    • A 56-year-old man experienced a transient ischemic attack and two ischemic strokes in the right middle cerebral artery (MCA) distribution.
    • Due to recurrent strokes with 65%-70% focal stenosis of the M1 segment of the right MCA, a Wingspan intracranial stent was placed.

    Stroke Treatment Protocols

    • Stroke patients require treatment in specialized stroke units or intensive care units.
    • Specialized stroke care correlates with lower mortality rates, shorter hospital stays, fewer discharges to nursing homes, and reduced costs.
    • Formation of a stroke team can expedite emergency response and care quality.
    • Emergency care must prioritize airway protection to prevent airway obstruction, hypoventilation, and aspiration.

    Emergency Care Interventions

    • Monitoring with pulse oximetry or arterial blood gases is recommended.
    • Supplemental oxygen and ventilatory support should be provided if required.
    • Mild hypothermia can protect the brain from ischemic damage, while hyperthermia can worsen outcomes.
    • Bedridden patients or those with oropharyngeal impairments need measures to prevent pulmonary complications, as pneumonia mortality rates can reach 15%-25% in stroke patients.

    Aspiration Risks and Management

    • Aspiration is common in stroke patients: over a third in brainstem strokes, one-fourth in bilateral hemispheric strokes, and one-tenth in unilateral hemispheric strokes.
    • For patients with oropharyngeal dysfunction, temporary enteral feeding tubes may be necessary for nutrition and medication administration.
    • Patients showing mild oropharyngeal dysfunction should not receive oral intake until assessed by a speech pathologist.

    Cardiac Function Assessment

    • Following stroke, assessment of cardiac function and blood pressure is crucial.
    • Continuous cardiac monitoring for 48 hours is recommended due to high rates of cardiac dysfunction post-stroke.
    • A 12-lead ECG and troponin level tests should be conducted immediately upon admission.
    • Concomitant cerebral and myocardial ischemia can occur in 3%-20% of stroke cases.

    Blood Pressure Management

    • Ischemic strokes may complicate with various cardiac arrhythmias; abnormal ECG or troponin levels necessitate serial monitoring.
    • Blood pressure should be closely monitored for 48-72 hours due to transient elevations post-stroke.
    • Optimal post-stroke blood pressure targets are 160-200 mm Hg for systolic and 70-110 mm Hg for diastolic pressures.
    • Both lower and higher blood pressure ranges can correlate with increased stroke volumes on CT scans within 4-7 days post-event.
    • Management of transient blood pressure elevations remains controversial, with the need to avoid overtreatment that could lead to hypotension.

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    Description

    This quiz focuses on the surgical therapy for symptomatic carotid artery stenosis, a significant contributor to ischemic strokes. It covers the development of atherosclerosis in the carotid artery and the implications of plaque structure and stenosis degree in stroke risk.

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