Medical Pharmacology Chapter 42:  Evaluation, Risk Assessment and  Anesthesia for Cardiovascular Procedures

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Cerebrovascular Disease

 

  • Generally in patients with atherosclerotic disease, survival is dependent upon management of myocardial ischemia

  • Correlation has been demonstrated between, & internal carotid artery intimal wall thickness and coronary heart disease incidence

  • Anesthetic management approach:

    1. Prevent myocardial ischemia first

    2. Prevent neurological events second

  •  Surgical intervention to manage cerebrovascular insufficiency (e.g., carotid endarterectomy) is associated with noteworthy morbidity/mortality

Ultrasound:  Vascular Carotid Imaging (images:Agilent Technologies)

 

Clinical Presentation: a 69-year old man presented with transient episodes of left arm weakness

  • Mild wall thickening: left common carotid.

  • From Carotid Artery Stenosis by Thomas F. Gudas, M.D., and Benjamin Faitelson, M.D., 1994

  • Mild wall thickening: internal carotid

  • From Carotid Artery Stenosis by Thomas F. Gudas, M.D., and Benjamin Faitelson, M.D., 1994

(Left);    (right)-- ; from Carotid Artery Stenosis by Thomas F. Gudas, M.D., and Benjamin Faitelson, M.D., 1994;

Carotid Artery Stenosis 

(courtesy G.E. Imaging,)

 

  • Primary Reference: Katz, J.,  Evaluation Risk Assessment of Patients with Vascular Disease in Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 201-218, 1998.
 
 

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