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

2. 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

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

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

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

6. 可能診斷？ Right carotid artery stenosis

7. 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.

8. 診斷 ？ Critical right carotid artery stenosis

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

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

11. 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.

12. Question

13. 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

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