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14 Cards in this Set
- Front
- Back
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Name the CEA / CAS trials |
NASCET: N. Am Symptomatic CEA Trial
ACAS: Asymptomatic Carotid Artery Stenosis trial
CREST: carotid revascularization endarterectomy vs stenting trial |
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NASCET findings |
CEA for symptomatic stenosis >70% reduced stroke and death |
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ACAS findings |
Asymptomatic patients with carotid stenosis >60%, reduced risk of stroke or death at 5 years |
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CREST findings |
CAS vs CEA in symptomatic and asymptomatic patients
Comparable rates (death, stroke, MI, ipsi stroke at 4 years) but periop stroke more frequent in CAS and MI more frequent with CEA |
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How does hyperperfusion syndrome present |
Tight stenosis / poor collaterals --> undergoes CEA --> impaired autoregulation --> HA, AMS, seizures, hemorrhage
After CEA, if autoregulation is impaired (esp patients with tight stenosis and poor collaterals) may present wit HA, mental status changes, seizures, hemorrhage |
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Work-up for hyperperfusion syndrome after CEA |
TCD MR perfusion CT perfusion |
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Symptoms / signs of CN injury after CEA |
CN 5, 9, 10
Tongue deviation (ipsi) - hypoglossal
Hoarseness - recurrent laryngeal nerve
Lip asymmetry - mandibular nerve |
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Most common cause of major post-op TIA after CEA |
Thrombosis of CEA site |
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Treatment (medical) for post-op thrombosis after CEA |
Pressors (phenylephrine) to elevated SBP to 180-200
Fluids, reduce blood viscosity
Heparinize |
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New onset stridor and pulsatile neck mass after CEA, diagnosis? |
Ruptured arteriotomy closure
Tracheal compression |
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Peak incidence of hyperperfusion syndrome |
POD #6 |
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Focal neurologic signs within first week or 2 after CEA, next step? |
TCD, if >100% increase in perfusion - aggressive BP management, stop anticoagulants, mannitol, AEDs
CT, if negative, MRI/MR perfusion |
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Focal neurologic signs within first week or 2 after CEA, next step? |
TCD, if >100% increase in perfusion - aggressive BP management, stop anticoagulants, mannitol, AEDs
CT, if negative, MRI/MR perfusion |
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Post- EC/IC bypass, SBP goals |
Tight control 130-160mm Hg |
