Transient Ischemic Attacks and Carotid Artery Stenosis

1
Transient Ischemic Attacks and Carotid Artery
Stenosis

• ?????? ?????

2
??????

• A 63 year-old woman who is a patient of
  hypertension and CAD s/p CABG 6 months before

3
??

• An episode of left hemiplegia which lasted for
  only one hour 5 days before .

4
???????

• ???
• Transient Ischemic Attack (TIA)
• Stroke
• Ans. A

5
????

• Blood pressure 132/80 mmHg , heart rate 74/min
  regular.
• Loud bruits over the right neck .

6
?????

• Right carotid artery stenosis

7
?????

• Carotid duplex ultrasonography showed severe
  stenosis (74) in the right carotid bulb.
• Carotid arteriography revealed a critical
  stenosis (90) at the right common critical
  artery near the bifurcation with hypoplasia of
  the right external carotid artery and left
  vertebral artery.

8
?? ?

• Critical right carotid artery stenosis

9
??

• During the carotid arteriography, another episode
  of left hemiplegia occurred, which resolved in an
  hour

10
?????

• Critical right carotid artery stenosis with
  crescendo TIA

11
????

• Right carotid endarterectomy with patch
  angioplasty.
• Another episode of TIA( transient ischemic
  attack) on POD 1.
• Was discharged soon without any neurological
  sequellae.

12
Question
13
Question 1.

• ???
• What are the indications for carotid
  endarterectomy?
• Ans.Stenosisgt70
• .Hemispheric TIA,s
• .Evidence for lack of collateral vessels
• .Tandem extracranial and intracranial occlusive
  lesions
• .Overall good health

14
Question 2.

• ???
• What is the clinical implication of TIA with
  increasing frequency and/or severity (crescendo
  TIA)?
• Ans.Impending stroke.