c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Cerebrovascular Disease: 10

A D V E R T I S E M E N T

   
 

Angiogram has largely been replaced by doppler, duplex scan and magnetic resonance angiography (MRA) diagnosis for carotid occlusive disease.       

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Cerebrovascular Disease: 11

A D V E R T I S E M E N T

   
 

A patient who has had a TIA secondary to carotid disease has a 24% risk of developing a frank stroke in the next year and a half with medical management alone. Surgically removing the plaque (carotid endarterectomy) decreases the risk to 7%. The nature and extent of carotid disease is now most commonly diagnosed non-invasively using duplex scan or magnetic resonance angiography (MRA). The older invasive technique of angiography is still the gold standard for precision, but is seldom used.     

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Cerebrovascular Disease: 12

A D V E R T I S E M E N T

   
 

Carotid endarterectomy is now a common operation with a low morbidity and mortality (1%) in the hands of surgeons who do the operation frequently. It can be done under local anesthesia. An incision is made in the carotid bulb and proximal internal carotid. A temporary shunt may be used if a clamp time longer than 10 or 15 minutes is anticipated or if pressure in the distal stump is less than 40-50 mm Hg, indicating poor collateral flow. Some surgeons routinely use shunts, some never. The plaque is carefully shelled out leaving the remaining media of the vessel (see carotid endarterectomy). Distal intimal edges are tacked down if necessary to prevent dissection and secondary occlusion. If the lumen might be compromised by closure, a vein graft patch is used.    

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This page was last modified on 7/20/1999.