UWORLD ABFM || A+ Guaranteed.
[Educational objective]
Tx for COMPLETE (**100%**) occlusion of the carotid artery / asymptomatic patient correct
answers risks of CEA outweigh its benefits b/c absence of sx indicates the presence of adequate
collateral blood flow. Medical therapy only.
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
What % stenosis in carotid artery atherosclerosis is needed for any management. correct answers
>50% stenosis needs management which includes medical therapy in ALL patients and
evaluation for carotid endarterectomy (CEA) for SELECT patients.
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
medical therapy management of carotid artery atherosclerosis (ie stenosis >50%) correct answers
aspirin, statin, antihypertensives, diabetes management, smoking cessation
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
Define symptomatic in carotid artery atherosclerosis correct answers TIA or ischemic stroke in
the distribution (ie on the correct side) of the affected vessel within the past 6 months
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
CEA is recommended correct answers In patients who have:
-a life expectancy >5 years AND
-are symptomatic from a high-grade lesion, eg, 70%-99%
(symptomatic = ie, transient ischemic attack or ischemic stroke in the distribution of the affected
vessel within the past 6 months)
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
Patients unlikely to benefit from CEA correct answers -those who have significant comorbidities,
ie, poor surgical candidates;
, -those who have had an ipsilateral stroke with persistent disabling neurologic deficits;
-those with COMPLETE "100%" OCCLUSION of the internal carotid artery.
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
Patients not benefiting from Carotid Endarterectomy (CEA): correct answers Patients not
benefiting from Carotid Endarterectomy (CEA):
1. significant comorbidities;
2. complete (100%) occlusion of the internal carotid artery;
3. hx ipsilateral stroke with persistent disabling sequelae.
Most common location of AAA correct answers Infrarenal
Size needed to be considered an AAA correct answers 3 cm or larger
Six risk factors for AAA.
Which one is worst ? correct answers Smoking... is worst
60 years or older
Male
White
Atherosclerotic disease
Family history of AAA
Pts to be screened for AAA: correct answers Male, 65-75, HISTORY OF SMOKING
AAA symptoms correct answers -Mostly asymptomatic
-May have abdominal, back, or flank pain
-Lower limb ischemia &/or thromboembolism
-Rupture often presents with abdominal distension and shock
AAA....Medical management:
When indicted?
What is it ? correct answers Smoking cessation (most important)
low dose Aspirin
Statin
Exercise
Interval ultrasound imaging
AAA... timing of interval imaging: correct answers 3-4 cm... Every 2-3 years
4-5.4 cm... every 6-12 months
5.5 cm > Needs elective surgery
[Educational objective]:
AAA... Possible indications for elective surgery: correct answers -Large: 5.5 cm or larger
[Educational objective]
Tx for COMPLETE (**100%**) occlusion of the carotid artery / asymptomatic patient correct
answers risks of CEA outweigh its benefits b/c absence of sx indicates the presence of adequate
collateral blood flow. Medical therapy only.
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
What % stenosis in carotid artery atherosclerosis is needed for any management. correct answers
>50% stenosis needs management which includes medical therapy in ALL patients and
evaluation for carotid endarterectomy (CEA) for SELECT patients.
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
medical therapy management of carotid artery atherosclerosis (ie stenosis >50%) correct answers
aspirin, statin, antihypertensives, diabetes management, smoking cessation
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
Define symptomatic in carotid artery atherosclerosis correct answers TIA or ischemic stroke in
the distribution (ie on the correct side) of the affected vessel within the past 6 months
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
CEA is recommended correct answers In patients who have:
-a life expectancy >5 years AND
-are symptomatic from a high-grade lesion, eg, 70%-99%
(symptomatic = ie, transient ischemic attack or ischemic stroke in the distribution of the affected
vessel within the past 6 months)
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
Patients unlikely to benefit from CEA correct answers -those who have significant comorbidities,
ie, poor surgical candidates;
, -those who have had an ipsilateral stroke with persistent disabling neurologic deficits;
-those with COMPLETE "100%" OCCLUSION of the internal carotid artery.
(Stroke. 2011 Aug;42(8):e464-540. doi: 10.1161/STR.0b013e3182112cc2. Epub 2011 Jan 31.
2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS
guideline on the management of patients with extracranial carotid and vertebral artery disease.)
Patients not benefiting from Carotid Endarterectomy (CEA): correct answers Patients not
benefiting from Carotid Endarterectomy (CEA):
1. significant comorbidities;
2. complete (100%) occlusion of the internal carotid artery;
3. hx ipsilateral stroke with persistent disabling sequelae.
Most common location of AAA correct answers Infrarenal
Size needed to be considered an AAA correct answers 3 cm or larger
Six risk factors for AAA.
Which one is worst ? correct answers Smoking... is worst
60 years or older
Male
White
Atherosclerotic disease
Family history of AAA
Pts to be screened for AAA: correct answers Male, 65-75, HISTORY OF SMOKING
AAA symptoms correct answers -Mostly asymptomatic
-May have abdominal, back, or flank pain
-Lower limb ischemia &/or thromboembolism
-Rupture often presents with abdominal distension and shock
AAA....Medical management:
When indicted?
What is it ? correct answers Smoking cessation (most important)
low dose Aspirin
Statin
Exercise
Interval ultrasound imaging
AAA... timing of interval imaging: correct answers 3-4 cm... Every 2-3 years
4-5.4 cm... every 6-12 months
5.5 cm > Needs elective surgery
[Educational objective]:
AAA... Possible indications for elective surgery: correct answers -Large: 5.5 cm or larger
