Transient Ischemic Attacks and Carotid Artery Stenosis A

Transient Ischemic Attacks and Carotid Artery Stenosis 心臟外科主任 林老生醫師

病患基本資料 • A 63 –year-old woman who is a patient of hypertension and CAD s/p CABG 6 months before

主訴 • An episode of left hemiplegia which lasted for only one hour 5 days before. •

您的初步診斷？ 選擇題 A. Transient Ischemic Attack (TIA) B. Stroke Ans. A

理學檢查 • Blood pressure 132/80 mm. Hg , heart rate 74/min regular. • Loud bruits over the right neck.

可能診斷？ • Right carotid artery stenosis

儀器檢驗㎞ • Carotid duplex ultrasonography showed severe stenosis (74%) in the right carotid bulb. • Carotid arteriography revealed a critical stenosis (~90%) at the right common critical artery near the bifurcation with hypoplasia of the right external carotid artery and left vertebral artery.

診斷 ？ • Critical right carotid artery stenosis

病程 • During the carotid arteriography, another episode of left hemiplegia occurred, which resolved in an hour

進一步診斷 • Critical right carotid artery stenosis with crescendo TIA

治療過程 • Right carotid endarterectomy with patch angioplasty. • Another episode of TIA( transient ischemic attack) on POD 1. • Was discharged soon without any neurological sequellae.

Question

Question 1. 問答題 • What are the indications for carotid endarterectomy? • Ans. Stenosis>=70% ．Hemispheric TIA，s ．Evidence for lack of collateral vessels ．Tandem extracranial and intracranial occlusive lesions ．Overall good health

Question 2. 問答題 • What is the clinical implication of TIA with increasing frequency and/or severity (crescendo TIA)? • Ans. Impending stroke.