Carotid and Vertebral Vasculopathies Overview & Examples of Atherosclerotic Disease
HIDEInteractive Transcript
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Today, we're going to talk about carrotid and vertebral vasculopathies.
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We'll talk first about atherosclerotic
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disease, the most common cause of
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vasculopathy in older patients.
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We'll talk about treatment-related entities
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such as radiation vasculitis and iatrogenic.
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We'll talk about structural abnormalities
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including carotid web, dissection, and
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connective tissue disorders, the most
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common being fibromuscular dysplasia.
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And we'll talk about some inflammatory
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and infiltrative conditions such as And
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TAUs and a few other entities such as
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infection and neoplastic, invasion of
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vessels that can cause narrowing in strokes.
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So, as I said, we're first gonna
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talk about atheros disease.
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Risk.
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Factors for atheros disease are hyperlipidemia,
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hypertension, and diabetes, among other factors.
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Um, the most common places for plaques to
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form are in the aortic arch, the carotid
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bifurcation, and the MCA bifurcations.
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When there's severe atheromatous disease,
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patients tend to get border zone infarcts,
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such as shown here, between the MCA and
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ACA, and between the MCA and PCA, and you
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get basically a straight line of strokes.
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It's called man in a barrel syndrome, because
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the feet map out medially and the hands map
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out laterally, and the proximal vessels,
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proximal arm and leg, End up in the border zone.
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So you can only use your arms and legs.
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So radiation vasculitis is basically the
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pathology is accelerated atherosclerosis.
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So, the risk factors are obviously radiation
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dose and the other risk factors for
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atheromatous disease such as hyperlipidemia.
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The incidence is approximately 40 percent with
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greater than 50 percent stenosis at 5 years
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and 15 percent of Patients who get significant
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radiation to the neck have greater than 70
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percent stenosis at 5 years as shown here.
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The patients tend to have longer
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segments of atheromatous disease
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and it progresses more rapidly.
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So, this is a patient who had radiation
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was imaged initially in August
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of 2014, and then 9 months later.
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is imaged again and has severe
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stenosis in the carotid arteries.
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It wouldn't progress that fast
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just with normal atheromatous disease.
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The patient also has a higher
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incidence of complications after
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carotid endarterectomy and stenting.
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
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