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Carotid Pathology II

Carotid Pathology II. Fibromuscular Dysplasia. Characterized by fibro tissue proliferation. Arterial involvement segmental up to several cm. ICA most common of cervical vessels 85%. May result in carotid dissection & or thrombotic embolic. Fibromuscular Dysplasia. Mid-Distal ICA.

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Carotid Pathology II

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  1. Carotid Pathology II

  2. Fibromuscular Dysplasia • Characterized by fibro tissue proliferation. • Arterial involvement segmental up to several cm. • ICA most common of cervical vessels 85%. • May result in carotid dissection & or thrombotic embolic.

  3. Fibromuscular Dysplasia Mid-Distal ICA “String of Beads”

  4. Fibromuscular Dysplasia Alternating Zones of Narrowing by Spectral Normal ICA Waveform

  5. Subclavian Steal Phenomenon • Occurs with a high-grade stenosis or occlusion of the proximal subclavian or innominate arteries. • Diversion of blood from the high-pressure vertebrobasilar circulation to the low-pressure upper extremity circulation via “Retrograde” vertebral artery flow. • Brachial systolic pressure > 15-20 mm Hg indicates obstruction

  6. Subclavian Steal Phenomenon 85% 15%

  7. Subclavian Steal Phenomenon Incomplete Complete Bunny/Pre-steal Tardus-Parvus

  8. Subclavian Steal Phenomenon Right Vertebral

  9. Subclavian Steal Phenomenon Left Vertebral

  10. Subclavian Steal Phenomenon Right Subclavian

  11. Subclavian Steal Phenomenon Incomplete to Complete Steal Cuff Induced Hyperemia Incomplete Steal

  12. Carotid Endarterectomy • Diseased intima “shelled” out & artery wall closed/sutured • Vein patch or Synthetic material (polytetrafluoroethylene) used to enlarge site of stenotic narrowing • Duplex sonography to confirm patency, presence of flaps, & stenosis due to neointimal hyperplasia

  13. Follow-Up Carotid Endarterectomy • 3, 6, 12 Month follow-up exams • Postendarterectomy flow disturbances: • spectral broadening - rough subintimal layer, • stenosis/occlusion caused • by intimal flap • retained plaque • neointimal hyperplasia, • ICA often exhibits an “Externalized” waveform

  14. Follow-Up Carotid Endarterectomy • 2 years post surgery when most (70%) of re-stenosis occur. • Re-stenosis within the first 3 years results from progression of neointimal hyperplasia.

  15. Follow-Up Carotid Endarterectomy

  16. Follow-Up Carotid Endarterectomy

  17. Follow-Up Carotid Endarterectomy

  18. Follow-Up Carotid Endarterectomy

  19. Follow-Up Carotid Endarterectomy

  20. Follow-Up Carotid Endarterectomy

  21. Follow-Up Carotid Endarterectomy Normal Turbulence

  22. Follow-Up Carotid Endarterectomy Graft ICA

  23. Follow-Up Carotid Endarterectomy Neointimal Hyperplasia Stenosis

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