Transcript Non-Atherosclerotic Arterial Obstructive disease

Non-Atherosclerotic Arterial
disease-Cerebral
• Hemorrhage: Underlying cause of 16% of
all strokes.
– Hypertension is leading cause of cerebral
hemorrhage.
– Aneurysm: can be congenital or result from
atherosclerosis.
Hemorrhage cont.
• Trauma can cause intracerebral or
subarachnoid bleed.
• Thrombolytic Therapy: Lysis of thrombus
(dissolution of or decomposition of
thrombus)
• Heparin Therapy: anticoagulant
Hemorrhage cont.
Non-athero cerebral:
• Emboli
– Greatest number of cerebral emboli come from
the heart.
– Most go to the posterior circ
– Numerous materials can embolize.
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Air
Tumor
Thrombus
atherosclerosis
Cerebral cont.
• Aneurysm
– Congenital: Berry (small, sacular), Arteriovenous malformation (avm) artery and vein
connected causing shunting of flow.
– Hypertension
– Trauma (AVM)
Non-athero cerebral cont.
• Inflammatory conditions:
– Sickle Cell: young, African-American population
– Periarteritis Nodosa/Polyarteritis:
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A collegen / allergic disease
Necrosis of media and thickening of the intima
Segmental arteritis and possible small aneurysms occur
Can obstruct function of any arterial system involved
Cerebral cont.
• Temporal Arteritis
– Intimal proliferation and inflammation/cause unknown/
because patients also have polymyalgia rheumatica it is
considered a rheumatic disease.
– It affects medium size branches of carotid arteries,
coronaries, aorta and it’s branches.
– Complications: blindness, stroke, heart attack, and
norrowing of major aortic branches.
– 50 YO women. Women>Men.
Non-athero extracranial causes .
• Takayasu’s: also a form of arteritis and is
distinguished from Temporal Arteritis
microscopically and clinically.
– Predominantly affects young women,Asian.
– Involves predominantly the aortic arch and it’s
branches. Death is caused by CHF and CVA
– Treated with corticosteroids
Non-athero extracranial causes
cont.
• Periarteritis nodosa/ polyarteritis
– An inflammatory disease of small and medium sized
arteries. Affects any organ or body system.
• Temporal Arteritis
• Reference: Cardiology Clinics PVD in the
Elderly. 8-1991.
• Reference: Diseases of the Heart and Circulation.
3rd ed. Wood, Paul page.727
Non-athero extracranial cont.
• Carotid Body Tumor
– Carotid body: 1X1 mm, in adventitia at carotid
bifurcation, a component of the autonomic nervous
system that helps control arterial PH, blood gas level,
and blood pressure.
– A paraganglioma, low incidence of malignance, highly
vascular.
– Located most often between ECA and ICA.
– Causes palpable mass, neck pain, headache, laryngeal
nerve palsy, and invasion of carotid arteries.
Non-athero causes extracranial
• Dissection: Under forced pressure blood separates
layers of the arterial wall.
– Usually trauma
– Can be spontaneous
– Spontaneous dissection many times results with
nonviolent trauma: exercise or rapid neck motion.
– Contributing factors to spontaneous dissection:
hypertension, fibromuscular hyperplasia, and
conditions that weaken the arterial wall – Marfan’s
syndrome, cystic medial necrosis, and Ehlers-Danlos
syndrome.
Dissection cont.
• Thrombosing is associated
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Occlusion or hemdynamic stenosis
Embolic source
Either can cause TIA/CVA
Anitcoagulate or thrombectomy and repair wall
Dissection cont.
• A false lumen is created.
• If separation is between media and adventia
a pseudoaneurysm can occur.
Non-athero renal pathologies
• Fibromuscular Dysplasia: Hyperplasia of the
media or intimal layer of the renal artery. Forms
concentric bands usually located in the mid to
distal renal arteries.
– Occurs more frequently in women
– Onset can be at early age (teens) or before 50.
– More than one band forms creating “tandem lesions).
Known as “string of beads” on arteriogram.
Non-athero renal pathologies
• Rare causes of renovascular disease
– Takayasu’s/ Polyarteritis
– Renal artery thrombosis or embolism
– Extrinsic renal artery compression by cyst or
tumor
– Abdominal aortic coarctation
– Congenital vascular lesions
– Reference: Bernstein, 4th ed, page 652
Non-atherosclerotic mesenteric
lesions
• Compression syndrome
– Median Arcuate ligament can compression the
lumen of the celiac trunk or SMA
– This is most often intermittant
– Rarely a cause of bowel ischemia
Non-athero mesenteric lesions
cont.
• Emboli
– Most often from heart
– Thrombus
– Tumor
References Vas Phy 2
• Slide 1 Handout from Bowman Grey lecture on
carotid duplex, 1984.
• Slide 2 Cardiology Clinics, PVD in Elderly,
August 1991, Saunders. Breslin, Ed. Pgs.508-509
• Slides 5 & 7 Taber’s Cyclopedic Medical
Dictionary, Davis, 1985.
• Slide 6 Diseases of the Heart and Circulation 3rd
ed. Wood’s, Paul. Lippincott, 1969.pg 727.
Refer Vas Phy 2 cont.
• Slides 7,8,9 Cardiology Clinics, PVD in Elderly,
August 1991. PGS 547-553
• Slide 10 Introductin to Vascular Ultrasound, 4th
Ed., Zwiebel, Saunders, 2000.pgs. 163-165 &160.
• Slides 11,12,13 Cardiology Clinics, PVD in
Elderly, August 1991. Pg.528. / Introduction to
Vascular Ultrasound,4th Ed. Pages 156-161.
Ref Vas Physi 2 cont.
• Slide 14 Cardiology Clinics, PVD in
Elderly, August 1991. Pgs 528-530./ Ciba,
Heart vol 5. 1981, Pg 229.
• Slide 15 Vascular Diagnosis, 4th Ed.,
Bernstein, Mosby, 1993, Pg 652
• Slide 16 Introduction to Vascular
Ultrasonography, Zwiebel 4th, Ed.
Saunders,2000 Pgs 421-422.