CH 8 & 9 UNCOMMON PATHOLOGY OF THE CAROTID ARTERY QUESTIONS AND ANSWERS 2024

CH 8 & 9 UNCOMMON PATHOLOGY OF THE CAROTID ARTERY QUESTIONS AND ANSWERS 2024 Tortuosity and Kinking - Correct Ans->- length of the vessel exceeds the fixed distance from the bifurcation to the skull, it's forced to curve and wind to make space. - vary from small curves to very sharp angulations - may be 16% of patients - can be bilateral Sign and symptoms: - Correct Ans->• asymptomatic • TIA like symptoms specially with head turning • Pulsatile mass, particularly w/ CCA tortuosity US evaluation of torturous vessel - Correct Ans->increased velocities distal to curves and kinks - Sampling is from the straight portion How do scan tortuous vessels? - Correct Ans->The angel cursor must be adjusted frequently to compensate for the changing vessel direction, AKA get spectral at straightest portion - Prox to curve and distal to curve" Dissections/Intimal Flaps - Correct Ans->• Separation of the layers of an artery due to intimal tear, typically intima from media • Intimal flap by flutter in the arterial lumen • May lead to pseudoaneurysm formation • Results in creation of false vessel lumen Different types of dissection/intimal flaps - Correct Ans->1. blind end: not a full tear where blood comes back out 2. secondary: connect to true lumen through tear & blood exits and exits both ends. causes of dissection/intimal flaps - Correct Ans->• Trauma • Hypertension • Following carotid endarterectomy • May be associated with other diseases(FMD, Marfan syndrome, Ehler-Danlos syndrome) • Extension into the CCA from an aortic dissection Sign and symptoms of dissection/intimal flaps - Correct Ans->• Asymptomatic• Unilateral head, face, or neck pain (usually associated with ICA dissection) • Hemispheric stroke or TIA symptoms • Dissection should be suspected in young patients who present with stroke symptoms. where to place cursor when doing doppler for Tortuous vessels? - Correct Ans->SETTING THE MIDDLE OF THE ANGLE CORRECT CURSOR PARALLEL TOTHE VESSEL WALL, whether it be straight or tortuous False Lumen flow patterns when there is a dissection - Correct Ans->- High resistance flow pattern - Blood flow into and out of the false lumen in a to-and-fro pattern - No flow as thrombus may form - Reversed flow direction Where dissections most commonly occur? - Correct Ans->Most dissections occur in the thoracic aorta Dissections - who is most commonly affected and what would their symptoms be? - Correct Ans- >DISSECTION SHOULD BE SUSPECTED WHEN YOUNG PEOPLE BETWEEN 35 & 50 PRESENT WITH STROKE SYMPTOMS, WITH NO RISK FACTORS FOR ATHEROSCLEROSIS, PARTICULARLY IF THERE IS A HISTORY OF TRAUMA