Vascular Test Prep

Question 1

Difference between CVA and TIA?

Answer 1

CVA is permanent or semi-permanent impairment, while TIA is a mini stroke, with symptoms lasting under 24 hours.

Question 2

Vertebral-basilar symptoms (AKA back of the brain symptoms)

Answer 2

• drop attacks
• blackouts
• syncope
• Memory loss
• Vertigo
• Dizziness
• Diplopia

Question 3

Causes of CVA

Answer 3

1. Cardiac: emboli or cessation of perfusion
2. Carotid etiology=50%: ischemia, thrombosis-occlusion, emboli to brain
3. Aneurysm rupture: intracranial hemorrhage, vasospasm

Question 4

Risk factors of Cerebrovascular Disease (Atherosclerosis):

Answer 4

family history of Peripheral Artery Disease or Heart Disease
Smoking
Old Age
Diabetes Mellitus
Hypertension
High Cholesterol/Hyperlipidemia

Question 5

What % of population has an intact Circle of Willis?

Answer 5

50%

Question 6

Carotid Artery scanning protocol:

Answer 6

Pt. history
Transverse imaging
Longitudinal imaging
Color Doppler
Spectral Doppler
"mapping" of any areas of flow disturbance
Bruit

Question 7

ECA is ________, while ICA is _________.

Answer 7

medial, lateral

Question 8

Where do you scan from to get the carotid best?

Answer 8

Posterolateral

Question 9

Anatomical Differences between ICA and ECA:

Answer 9

• Posterior Position of ICA
• branches of ECA
• ICA is larger, though not reliable with disease

Question 10

Doppler waveform differences between ICA and ECA:

Answer 10

ICA=low resistance

ECA= high resistance (oscillations with temporal tap)

Question 11

From the distal CCA, pivot the probe towards the ______ to view ECA, and towards the ______ for the ICA.

Answer 11

chin, bed

Question 12

Which view gives most accurate view of plaque?

Answer 12

Transverse

Question 13

Color scale for arterial scans

Answer 13

around 30

Question 14

Color scale for venous scans

Answer 14

around 12

Question 15

What does Color Doppler Flow Imaging evaluate for? (3 things)

Answer 15

1. presence of flow
2. direction of flow
3. quality of flow (laminar vs. turbulent)

Question 16

Two ways to acquire an angle

Answer 16

1. Rock probe (heel-toe)

2. steer the color box

Question 17

What does perpenducular incidence look like?

Answer 17

both red and blue are seen

Question 18

Direction of blood flow in neck artery:

Answer 18

right side of screen to left

Question 19

Direction of blood flow in neck vein:

Answer 19

left side of screen to right

Question 20

Bulb of CCA may show

Answer 20

Eddy flow/flow separation

Question 21

Maintain a spectral doppler angle as close to ___ as possible.

Answer 21

60 degrees

Question 22

Angle correct to _____ wall.

Answer 22

posterior

Question 23

Overangle correction results in

Answer 23

overestimation of velocities

Question 24

Triangle F=

Answer 24

Detected Frequency shift

Question 25

Fo=

Answer 25

Transmitted Freq.

Question 26

2=

Answer 26

Transmit/receive time

Question 27

c=

Answer 27

speed of sound in soft tissue

Question 28

V=

Answer 28

velocity of blood

Question 29

Cos Theta=

Answer 29

cosign of incidence angle

Question 30

Doppler sample locations

Answer 30

Prox, Mid, Dist CCA and ECA, and Dist ICA

Question 31

4 steps to mapping a stenosis:

Answer 31

1. Visualize Plaque 2. Work Doppler sample volume through the stenotic region (3D) 3. Record and Measure highest velocity (take 2 or 3 samples) 4. Sample and record distal to stenosis to detect turbulence (if any)

Question 32

When looking for possible trickle flow, use

Answer 32

low scale (reduced PRF)

Question 33

What does NASCET stand for?

Answer 33

North American Symptomatic Carotid Endarterectomy Trials

Question 34

What does ACAS stand for?

Answer 34

Asymptomatic Carotid Atherosclerosis Study

Question 35

Consensus goals of 2003 Society of Radiologists in US:

Answer 35

- to simplify the confusing array of various criteria | - to standardize categories and thresholds

Question 36

What did the NASCET study show?

Answer 36

A benefit to carotid endarterectomy (CEA in SYMPTOMATIC patients with a >/= 70% diameter reduction

Question 37

Consensus recommendations for standardization:

Answer 37

- exams performed by accredited organization - Doppler angles should be 60 degrees or less - ICA should be interrogated from bulb to distal segment to reach maximu stenotic region - Report should include velocities,etc - On angiograms, the stenosis should be measured using the NASCET method - VELOCITY MEASUREMENTS FOR ICA STENOSIS SHOULD BE OBTAINED FROM THE POINT OF MAXIMUM STENOSIS

Question 38

What is the ICA PSV and ICA EDV for a normal degree of stenosis?

Answer 38

PSV= <40

Question 39

What is the ICA PSV and ICA EDV for <50% degree of stenosis?

Answer 39

PSV= <40

Question 40

What is the ICA PSV and ICA EDV for a 50-69% degree of stenosis?

Answer 40

PSV= 125-230, EDV= 40-100

Question 41

What is the ICA PSV and ICA EDV for a >/=70 but < total occlusion degree of stenosis?

Answer 41

PSV=>230, EDV= >100

Question 42

What is the ICA PSV and ICA EDV for near occlustion?

Answer 42

PSV= high, low or undetectable; EDV= Variable

Question 43

What is the ICA PSV and ICA EDV for total occlusion?

Answer 43

PSV= undetectable, EDV= N/A

Question 44

Three potential characteristics of plaque morphology:

Answer 44

1. Homogenous 2. Heterogenous 3. Calcified( presence of acoustic shadow)

Question 45

Indications for imaging the vertebral arteries:

Answer 45

Primary: for detection of flow direction Also: to evaluate for abnormal waveforms indicating stenosis or occlusion

Question 46

Indications for imaging the subclavian arteries:

Answer 46

Primary: for detection of subclavian stenosis Also: to follow up after a difference in arm pressures is detected

Question 47

A _______ gradient between left and right brachial pressures suggests subclavian stenosis?

Answer 47

20mmHg, arm with lower pressure has stenosis!

Question 48

When does a subclavian steal occur?

Answer 48

When there is an occlusion blocking blood from getting to a subclavian artery, blood is rereouted

Question 49

Early systolic deceleration (ESD)

Answer 49

AKA Bunny Rabbit waveforms, changing pressure patterns in the left arm in the presence of proximal subclavian artery stenosis affect the vertebral waveforms.