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13 Cards in this Set

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What anatomical aspects of a carotid lesion would bias towards stenting over CEA?

What historical features?
High carotid bifurcations or lesions below the clavicle

History of neck surgery
Prior neck radiation
Prior CEA

Contralateral laryngeal palsy is relative contraindication
What are complications of carotid endarectomy?
Cranial and cervical nerve injury
Myocardial infarction
Hyperperfusion syndrome

Wound complications
What are complications of carotid artery stenting?
Bradycardia
Carotid dissection
Vasospasm (usually transient)
External carotid stenosis
Hyperperfusion syndrome

Deployment failure
Stent migration
How soon after event should revascularization of carotids take place?
2 weeks
How does hyperperfusion syndrome typically present?
Headache
Focal symptoms
Seizures

Rarely parenchymal edema
Subarachnoid hemorrhage
Intracranial hemorrhage
Follow up after carotid revascularization?
Noninvasive imaging at 1 and 6 months
Antithrombotic therapy for carotid revascularization
For CEA:
Aspirin
Clopidogrel
Aspirin plus dipyramidole

For stenting:
Aspirin and Clopidogrel for 30 days minimum

Also give statin regardless of LDL levels
How should restenosis of lesion cleaned by CEA or stenting be approached?
Revascularization using same criteria
What are surgical techniques for treatment of extracranial vertebral disease?
Endarterectomy
Vertebral artery transposition to CCA
Distal vertebral to occipital artery
What are surgical techniques for treatment of intracranial vertebral disease?
Endarterectomy
Occipital artery - PICA anastomosis
Superfical temporal artery - superior cerebellar artery anastomosis
How often do carotid and vertebral artery dissections sponatenously recanalize?
Complete in 54% carotid, 45% vertebral
Hemodynamically significant (less than 50%) in 75% carotid and 65% vertebral
What are the AHA/ASA guidelines for medical treatment of carotid/vertebral dissection?

Evidence?
Use of heparin, LMWH, warfarin or anti platelet drugs (ASA, plavix, aggrenox) reasonable for 3-6 months if extracranial carotid or vertebral dissection associated with TIA/stroke

No controlled studies, observational study suggests anticoagulation superior to ASA
When is carotid angioplasty and stenting considered for dissection?
When medical therapy has not worked.