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Transient Ischemic Attacks and Carotid Artery Stenosis

Transient Ischemic Attacks and Carotid Artery Stenosis. 心臟外科主任 林老生醫師. 病患基本資料. A 63 –year-old woman who is a patient of hypertension and CAD s/p CABG 6 months before. 主訴. An episode of left hemiplegia which lasted for only one hour 5 days before . 您的初步診斷？. 選擇題

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Transient Ischemic Attacks and Carotid Artery Stenosis

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  1. Transient Ischemic Attacks and Carotid Artery Stenosis 心臟外科主任 林老生醫師

  2. 病患基本資料 • A 63 –year-old woman who is a patient of hypertension and CAD s/p CABG 6 months before

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

  4. 您的初步診斷？ 選擇題 • Transient Ischemic Attack (TIA) • Stroke Ans. A

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

  6. 可能診斷？ • Right carotid artery stenosis

  7. 儀器檢驗㎞ • 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. 診斷 ？ • Critical right carotid artery stenosis

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

  10. 進一步診斷 • Critical right carotid artery stenosis with crescendo TIA

  11. 治療過程 • 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. 問答題 • What are the indications for carotid endarterectomy? • Ans.Stenosis>=70% ．Hemispheric TIA，s ．Evidence for lack of collateral vessels ．Tandem extracranial and intracranial occlusive lesions ．Overall good health

  14. Question 2. 問答題 • What is the clinical implication of TIA with increasing frequency and/or severity (crescendo TIA)? • Ans.Impending stroke.

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