Rutherford's 096: Cerebrovascular Disease: Carotid Artery Dissection скачать в хорошем качестве

Rutherford's 096: Cerebrovascular Disease: Carotid Artery Dissection

#CarotidArteryDissection #CAD #StrokePrevention #VascularDisease #TraumaticCAD #SpontaneousCAD #Diagnosis #Treatment #Antithrombotics #Stenting #Endarterectomy #Rutherfords This video explores Carotid Artery Dissection (CAD), a significant cause of stroke, especially in younger adults. CAD involves a tear in the inner lining of the carotid artery wall, allowing blood to collect between layers, forming an intramural hematoma. This hematoma can narrow or block the artery (stenosis/occlusion), weaken the wall causing a bulge (aneurysm), or trigger clot formation that can travel to the brain, causing a stroke (embolization). CAD can be spontaneous (occurring without obvious major injury) or traumatic (due to blunt or penetrating neck trauma, like whiplash, falls, or fractures). Spontaneous CAD is rare (around 2.6/100,000/year) and is associated with recent infection, hypertension, and migraines. Traumatic CAD occurs in under 1% of trauma patients overall but is higher in those with specific high-risk injuries like skull base fractures. Symptoms are often similar for both types, including headache (~80%), neck pain, Horner syndrome (~25%), and crucially, TIA or stroke (~56%). Diagnosis relies heavily on imaging. While conventional angiography was standard, it's invasive. MRI/MRA are excellent at visualizing the intramural hematoma directly and are non-invasive, but slower. CTA is faster, good in acute trauma, visualizes wall thickening and lumen issues, but uses radiation and contrast. Duplex Ultrasound is portable, non-invasive, useful for follow-up, and can show hematoma and flow, though it's operator-dependent and limited in view. Treatment aims to prevent stroke and stop the dissection from worsening. Initial treatment is typically medical with antithrombotic therapy (antiplatelets like aspirin or anticoagulants like warfarin) to prevent clot formation. The CADIS trial showed no significant difference in recurrent stroke/death between antiplatelets and anticoagulants, often favoring antiplatelets due to easier management. Treatment usually lasts 3-6 months. Thrombolysis can be considered for acute stroke if the patient meets standard criteria. Endovascular treatments (angioplasty and stenting), often with embolic protection, are used if medical therapy fails, is contraindicated, or for enlarging aneurysms. Open surgery is less common, reserved for specific complex cases or penetrating injuries unsuitable for endovascular repair, though it carries higher risks than similar surgery for atherosclerosis. Prognosis varies; trauma, existing stroke at diagnosis, or delayed diagnosis worsen outcomes. For spontaneous CAD, mortality is low (5%), and about 75% of arteries heal. Recurrence risk is about 1% per year, highest in the first couple of weeks. Long-term management includes risk factor control (BP, smoking) and avoiding straining.