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Holding Pressure: Carotid Endarterectomy
Manage episode 403484621 series 2648498
Authors:
Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California
Gowri Gowda - PGY1 at the University of California Davis Integrated Vascular Surgery Program
Steven Maximus- Vascular surgery attending at the University of California Davis, Director of the Aortic Center
Resources:
Rutherford’s 10th Edition Chapters: 88, 89, and 91
Houston Methodist CEA Dissection Video:
Part 1: https://www.youtube.com/watch?v=wZ8PzhwmSXQ
Part 2: https://www.youtube.com/watch?v=E_wWpRKBy4w
Outline:
1. Etiology of Carotid Artery Stenosis
Risk factors: advanced age, tobacco use, hypertension, diabetes.
Atherosclerosis as the primary cause.
Development of Atherosclerotic Disease and Plaque Formation
LDL accumulation in arterial walls initiating plaque formation.
Inflammatory response, macrophage transformation, smooth muscle cell proliferation.
Role of turbulent blood flow at carotid bifurcation in plaque development.
Clinical Features of Carotid Artery Stenosis
Asymptomatic nature in many patients.
Symptomatic presentation: Transient ischemic attacks, amaurosis fugax, contralateral weakness/sensory deficit.
Carotid bruit as a physical finding, limitations in diagnosis.
Importance of Evaluating CAS
Assessing stenosis severity and stroke risk.
Revascularization benefits dependent on stenosis severity.
Classification of Stenosis Levels
Clinically significant stenosis: ≥ 50% narrowing.
Moderate stenosis: 50%–69% narrowing.
Severe stenosis: 70%–99% narrowing.
Stroke Risk Associated with Carotid Stenosis
Annual stroke rate: ~1% for 50-69% stenosis, 2-3% for 70-99% stenosis.
Diagnosis and Screening
No population-level screening recommendation.
Screening for high-risk individuals as per SVS guidelines.
Carotid Duplex Ultrasound as primary diagnostic tool.
Additional tools: CT angiography, Magnetic Resonance Angiography.
Handling of 100 cm/sec, Internal/Common Carotid peak systolic velocity Ratio > 4.
Revascularization Criteria
Symptomatic Patients: 50-69% or 70-99% stenosis, life expectancy at least three or two years, respectively.
Asymptomatic Patients: 70% stenosis, considering life expectancy.
Surgical Indications and Contraindications
Indications: symptomatic patients, life expectancy considerations.
Contraindications: Stenosis
120 episodes
Manage episode 403484621 series 2648498
Authors:
Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California
Gowri Gowda - PGY1 at the University of California Davis Integrated Vascular Surgery Program
Steven Maximus- Vascular surgery attending at the University of California Davis, Director of the Aortic Center
Resources:
Rutherford’s 10th Edition Chapters: 88, 89, and 91
Houston Methodist CEA Dissection Video:
Part 1: https://www.youtube.com/watch?v=wZ8PzhwmSXQ
Part 2: https://www.youtube.com/watch?v=E_wWpRKBy4w
Outline:
1. Etiology of Carotid Artery Stenosis
Risk factors: advanced age, tobacco use, hypertension, diabetes.
Atherosclerosis as the primary cause.
Development of Atherosclerotic Disease and Plaque Formation
LDL accumulation in arterial walls initiating plaque formation.
Inflammatory response, macrophage transformation, smooth muscle cell proliferation.
Role of turbulent blood flow at carotid bifurcation in plaque development.
Clinical Features of Carotid Artery Stenosis
Asymptomatic nature in many patients.
Symptomatic presentation: Transient ischemic attacks, amaurosis fugax, contralateral weakness/sensory deficit.
Carotid bruit as a physical finding, limitations in diagnosis.
Importance of Evaluating CAS
Assessing stenosis severity and stroke risk.
Revascularization benefits dependent on stenosis severity.
Classification of Stenosis Levels
Clinically significant stenosis: ≥ 50% narrowing.
Moderate stenosis: 50%–69% narrowing.
Severe stenosis: 70%–99% narrowing.
Stroke Risk Associated with Carotid Stenosis
Annual stroke rate: ~1% for 50-69% stenosis, 2-3% for 70-99% stenosis.
Diagnosis and Screening
No population-level screening recommendation.
Screening for high-risk individuals as per SVS guidelines.
Carotid Duplex Ultrasound as primary diagnostic tool.
Additional tools: CT angiography, Magnetic Resonance Angiography.
Handling of 100 cm/sec, Internal/Common Carotid peak systolic velocity Ratio > 4.
Revascularization Criteria
Symptomatic Patients: 50-69% or 70-99% stenosis, life expectancy at least three or two years, respectively.
Asymptomatic Patients: 70% stenosis, considering life expectancy.
Surgical Indications and Contraindications
Indications: symptomatic patients, life expectancy considerations.
Contraindications: Stenosis
120 episodes
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