223 CVT EXAM 2 CEA/TCAR lecture
Questions With Solutions
velocities
what are the main criteria we use to determine if someone has a certain degree of stenosis?
70-80 (%), turbulence (distal), cleans (up as it enters skull)
when we find a high grade stenosis , which is what percent range? (____-____%),
- with high velocities, distal to it, we should find what? _____?____
- and what we really want to see is how it ___?____ up just before it goes into the back of the
head.
50 (% or greater category in ICA)
from those velocities, in the ICA, we have something mores specific-
Greater than 125 puts you in a category of ___?__% or greater
then we go into the end diastolic
CEA (carotid endarterectomy)
What was the main way that we treated a high grade stenosis in the ICA?
not likely (to intervene at 50%)
What happens we find someone with pathology of 50% or greater?
Is anything going to be done surgically? (not likely/likely?)
carotid (cut), plaque (pull out)
in a CEA they:
- cut open the ____?_____
- pull out the ___?____ as one big tube-like or plug structure
- sew it up and you are on your way
not likely (even if thought to come from there because we don't know it definitely is AND
medications -statins- are being shown to be very effective)
If that 50% stenosis in the ICA is thought to be showering plaque from it, might they go in to
take out the plaque? (not likely/likely?)
, stroke (ironic - going in to prevent one, but has the highest risk of)
with CEA, in the hands of a good surgeon it is a very successful procedure.
The #1 risk involved with CEA?
less (incidence of stroke)
any time you have one procedure with a higher incidence of STROKE, people are more apt to
take the one with (less/more?) incident of stroke even though it may have a higher risk of say an
MI
stent (even in the heart, we stent)
how do we fix most lower extremity stenosis?
complications, stroke
We used to do stents in the neck , but stopped, now we do new stents in the neck....
why did we stop doing the old stents in the neck
- too many ____?_____
What was the main difference between a stent in the neck and a carotid endarterectomy?
- higher incident of _____?_____
groin (femoral access), AO (to get from fem to cca), yes (plaque likely elsewhere, especially
bifurcations)
The OLD stenting method had higher risk of embolization due to the plaque being disrupted.
The OLD stenting method:
- where would you access to put the catheter? ____
- To go from the femoral to the carotid, where would you have to go? _____ (not IN the heart)
- If we have a high grade stenosis in the carotid, is it likely we have plaque in other
areas?______
- once the catheter is in the vessel beyond the plaque, there are protection devices that will
catch anything that ____?_____
- but it was on the way up to the ____?___, past the plaque, that was the problem because
there was nothing to catch the emboli ass it moved from fem to carotid
- you also had to sit the protective device properly, and when you RETRACTED it, that nothing
___?____ out of the device
embolizes (protective devices catch these once deployed), carotid (getting to was issue), came
(out of the device while retracting)
The OLD stenting method, cont.:
- once the catheter is in the vessel beyond the plaque, there are protection devices that will
Questions With Solutions
velocities
what are the main criteria we use to determine if someone has a certain degree of stenosis?
70-80 (%), turbulence (distal), cleans (up as it enters skull)
when we find a high grade stenosis , which is what percent range? (____-____%),
- with high velocities, distal to it, we should find what? _____?____
- and what we really want to see is how it ___?____ up just before it goes into the back of the
head.
50 (% or greater category in ICA)
from those velocities, in the ICA, we have something mores specific-
Greater than 125 puts you in a category of ___?__% or greater
then we go into the end diastolic
CEA (carotid endarterectomy)
What was the main way that we treated a high grade stenosis in the ICA?
not likely (to intervene at 50%)
What happens we find someone with pathology of 50% or greater?
Is anything going to be done surgically? (not likely/likely?)
carotid (cut), plaque (pull out)
in a CEA they:
- cut open the ____?_____
- pull out the ___?____ as one big tube-like or plug structure
- sew it up and you are on your way
not likely (even if thought to come from there because we don't know it definitely is AND
medications -statins- are being shown to be very effective)
If that 50% stenosis in the ICA is thought to be showering plaque from it, might they go in to
take out the plaque? (not likely/likely?)
, stroke (ironic - going in to prevent one, but has the highest risk of)
with CEA, in the hands of a good surgeon it is a very successful procedure.
The #1 risk involved with CEA?
less (incidence of stroke)
any time you have one procedure with a higher incidence of STROKE, people are more apt to
take the one with (less/more?) incident of stroke even though it may have a higher risk of say an
MI
stent (even in the heart, we stent)
how do we fix most lower extremity stenosis?
complications, stroke
We used to do stents in the neck , but stopped, now we do new stents in the neck....
why did we stop doing the old stents in the neck
- too many ____?_____
What was the main difference between a stent in the neck and a carotid endarterectomy?
- higher incident of _____?_____
groin (femoral access), AO (to get from fem to cca), yes (plaque likely elsewhere, especially
bifurcations)
The OLD stenting method had higher risk of embolization due to the plaque being disrupted.
The OLD stenting method:
- where would you access to put the catheter? ____
- To go from the femoral to the carotid, where would you have to go? _____ (not IN the heart)
- If we have a high grade stenosis in the carotid, is it likely we have plaque in other
areas?______
- once the catheter is in the vessel beyond the plaque, there are protection devices that will
catch anything that ____?_____
- but it was on the way up to the ____?___, past the plaque, that was the problem because
there was nothing to catch the emboli ass it moved from fem to carotid
- you also had to sit the protective device properly, and when you RETRACTED it, that nothing
___?____ out of the device
embolizes (protective devices catch these once deployed), carotid (getting to was issue), came
(out of the device while retracting)
The OLD stenting method, cont.:
- once the catheter is in the vessel beyond the plaque, there are protection devices that will
