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Cerebrovascular Disease

#CerebrovascularDisease #Stroke #IschemicStroke #HemorrhagicStroke #TIA #CarotidArteryDisease #CarotidStenosis #Embolus #Atherosclerosis #CircleOfWillis #AnteriorCirculation #PosteriorCirculation #CarotidEndarterectomy #BestMedicalTherapy #NeurologicalDeficit This video by Dr Gregory Weir discusses *cerebrovascular disease**, focusing primarily on **stroke**, which is the third leading cause of death in the Western world. There are two main types: **ischemic stroke**, caused by a blocked artery reducing blood flow, and **hemorrhagic stroke**, caused by a ruptured artery in the brain. Ischemic strokes are much more common, accounting for 80% of cases, often due to **emboli* or small vessel disease. If symptoms resolve within 24 hours, it's called a **transient ischemic attack (TIA)**. *Carotid artery disease**, where **atherosclerosis* leads to *carotid stenosis* (narrowing), is a significant concern as it can cause emboli to the brain. Although reduced flow due to stenosis is usually well-compensated by collateral supply via the **Circle of Willis**, debris from the plaque poses an embolic risk. The brain receives blood from the carotid arteries (anterior circulation) and vertebral arteries (posterior circulation). Symptoms differ depending on which circulation is affected. Diagnosis involves a *carotid duplex ultrasound* within 24 hours for stroke or TIA, assessing the degree of stenosis. Treatment for carotid stenosis includes *best medical therapy* for all patients (smoking cessation, antiplatelet agents, statins, hypertension and diabetes control, exercise). Surgery, specifically **carotid endarterectomy**, is indicated for 70-99% stenosis and may be considered for 50-70% stenosis based on individual risk. During a carotid endarterectomy, the plaque is surgically removed, sometimes with a temporary shunt and patch angioplasty. Surgery is not beneficial for complete (100%) occlusion. Asymptomatic significant carotid stenosis found incidentally is a subject of debate regarding surgical intervention. This presentation is based on "Vascular and Endovascular Surgery at-a-Glance". Cerebrovascular disease is discussed with emphasis on the causes, diagnosis and treatment