Anatomy
What is the largest artery in the body?
Aorta
what does PERRLA stand for?
Pupils, Equal, Round, Reactive (to), Light, and Accomodation
What device is used for all cerebral intevention procedures and why?
Embolic protection device, because cerebral artery inteventions can dislodge atheroma and other lesion debris that can cause an intraprocedural stroke
Why can Bradycardia occur during carotid inteventions?
Baroreceptor stimulation during inflation of the angioplasty balloon
Most self expanding stents are made of what?
nitinol (a nickel-titanium alloy)
What 3 arteries branch off of the aortic arch?
left subclavian artery
left common carotid artery
Brachiocephalic artery
What is the primary catheter used for carotid diagnostic procedures and why?
Pigtail or UF (universal flush catheter) because of side holes
What should the contrast/hep saline ratio be for interventional procedures and why?
1/3 contrast to 2/3 hep saline
quick inflations to not cause ischemia
most self expanding stents have a tendency to _____ during deployment?
jump forward
What medication would be given for an ischemic stroke?
What medication would NOT be given for a hemorrhagic stroke?
Anticoagulant
Thrombolytic
Where are baroreceptors located?
Carotid sinuses and aortic arch
an embolic protection device is placed where in relation to the lesion?
distal to the lesion
What are 3 materials needed for an interventional procedure?
- guiding catheter of 90 cm guiding sheath
- stiff exchange wire with a very soft tip
-embolic protection device
-angioplasty balloon
- self expanding stent
what are 3 potential complications of interventional procedures?
- carotid spasm
-bleeding, vascular access issues
-sustained bradycardia and hypotension caused by baroreceptor stretching
- carotid artery spasm, embolization, dissection, thrombosis, perforation
- TIA, stroke, intracranial hemorrhage
- renal dysfunction
- in-stent restenosis
What are 3 indications for CAS?
- stenosis greater than 70% and/or shows signs of instability
- lesion that is not amendable to surgical access
- radiation-induced CAS
- restenosis following endarterectomy
-unfavorable neck anatomy
-clinically significant cardiac, pulmonary or other disease that greatly increases the risk of anesthesia and surgery
What is a Bovine Arch?
Single brachiocephalic trunk originating from the aortic arch, splits into the bilateral subclavian arteries and a bicarotid trunk.
What should be assessed of the patient after every injection?
neurological assessments (speech and hand/grip strength)
what medication can also be used with contraindications to heparin?
what are 3 risk factors for a cerebrovascular accident?
- hypertension
- diabetes mellitus
-arrythmia
- high blood cholesterol and other lipids
- smoking
-physical inactivity
-family history
-renal impairment
What is needed to differentiate a hemorrhagic stroke from an ischemic stroke?
CT scan
The aortic arch can be classified into three types. What is used as the reference vessel?
The widest diameter of the left common carotid is used as a reference vessel.
What Image Intensifier angle, direction and degree, is best to view carotids in a diagnostic procedure?
LAO (left anterior oblique) 40 degrees
What is the pancake method? What order do materials go in?
The stacking of interventional materials in order for easy access and use during the procedure.
Filter wire (top)
Balloon
Stent
Filter Wire Retrieval System (bottom)
Predilation with a balloon is often preformed prior to deploying the stent, why?
to ensure that a stent can safely pass through the stenosis
What is considered the gold standard treatment to reduce the risk of carotid artery stenosis?
Surgical revascularization with a CEA (carotid endarterectomy)