Only $2.99/month

Rutherford Vascular (derroberts)

Terms in this set (176)

1. Life expectancy
- Symptomatic patients with high-grade stenosis can be considered for intervention when their life expectancy is 2-3 years
- However, asymptomatic patients should be expected to survive at least 3-5 years to derive significant benefit in stroke reduction with CEA

2. Age
- Older age not associated with an increased risk of complications after CEA
- However, numerous studies indicate that older patients are at significantly higher risk of stroke (and to a lesser degree, death) after carotid artery stenting

3. Gender
- Most of the major RCTs have found a greater benefit from CEA in males versus females
- Severe studies suggest that CAS may be associated with more complications than CEA in women

4. Functional status
- The patient should have a baseline level of function sufficient that a further neurologic event would result in serious deterioration in functional or cognitive ability
- Patients with dense neurologic deficits unlikely to benefit; mild-to-moderate dementia or limitation in functional ability should be undertaken only after detailed and careful discussions

5. Cardiac status
- CEA associated with an increased risk of overall cardiac events compared with carotid stenting
- Predictors of adverse cardiac events include uncompensated CHF and untreated significant coronary disease
- Symptomatic 70-99%: clinical risk assessment alone; stress testing for those who are symptomatic with active angina, new onset EKG changes, or new onset CHF
- Full cardiac workup for asymptomatic

6. Renal insufficiency
- Excluded from major trials
Associated with features of plaque instability and increased complication rates after CEA and CAS

7. Contralateral carotid occlusion
- May be associated with a small-to-moderate increase in stroke after CEA but not CAS