Surgical management of Cerebrovascular accidents.pptx

The second lecture in the vascular module for the final years MBBS students in King Edward Medical University , Lahore, Pakistan
classification - which patient need intervention

1. Surgical management of Cerebrovascular accidents

2. Stroke – Ischemic and Hhragic

3. Transient Ischemic Attack A neurologic event with stroke-like symptoms less than 24 hours in duration. Majority last for only a few minutes .

4. Presentation Cardiac/ Carotid Circulation ( Anterior/ posterior) Risk factors Morphology Risks

5. NASCET criteria A diameter-reducing carotid artery stenosis of 70%–99% by NASCET criteria is equivalent to a stenosis of 82%–99% by ECST methodology; likewise, a stenosis of 70%–99% by ECST criteria is equivalent to a stenosis of 50%–99% by NASCET criteria.

6. A majority of surgeons do not offer carotid revascularization to asymptomatic patients with <70% stenosis or symptomatic patients with <50% stenosis

7. Carotid endartrectomy Duplex Ultrasound Alone In Asymptomatic Patients With A 70%–99% Stenosis Or Symptomatic Patients With Clear Unilateral Identifying Focal Deficits With A ≥50% Stenosis. Secondary Imaging, Most Commonly CTA Up To 95% Of Ceas Can Be Undertaken Based On Du Findings.

8. Carotid Artery Stenting Performed via a transfemoral (CAS) or Transcarotid (TCAR) arterial revascularization approach. Preoperative planning, Evaluate aortic arch Carotid artery anatomy Plaque burden, Stent sizing and selection.

9. Pre-operative medication Under general anesthesia (GA), Regional anesthesia (RA) with deep or superficial cervical block, E ven under pure local anesthesia (LA),

10. Eversion endrectomy

11. Complications

12. Complications

13. Complications

14. Complications

15. Complications

16. Complications