Vascular Assessment of Cerebrovascular Disease

Details

Title

Vascular Assessment of Cerebrovascular Disease

Type

Stage One

Module code

HPS131

Requirement

Compulsory

Module objective

By the end of this module, the Clinical Scientist in HSST will be able to apply their expert knowledge, skills and experience in the clinical setting to undertake cerebrovascular assessment including: 

• transient ischaemic attack;
• ischaemic stroke;
• sickle cell disease (see also paediatric module);
• carotid stent surveillance;
• perioperative imaging for carotid endarterectomy;
• transcranial Doppler Imaging of the Circle of Willis;
• intraoperative and post-operative detection of emboli with non-imaging TCD. 

They will also be able to recognise, deliver, report and interpret the appropriate physiological test/s to address the findings following the initial clinical assessment. They will be expected to apply their expert knowledge of the investigative findings and management options available to discuss management plans with the patient and/or the supervising clinician based. The Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations using the professional attributes and insights required of a Consultant Clinical Vascular Scientist.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to the assessment of a range of patients, including those with complex, urgent or critical problems referred for cerebrovascular assessment including: 

Anatomy, Physiology and Pathology

• typical anatomy and common variants of the extracranial and intracranial arterial system.
• common collateral pathways in the intracranial circulation
• the range and variety of pathology e.g., carotid artery disease, dissection,thrombosis, aneurysm, intracranial stenosis, emboli.
• features of plaque morphology that may relate to greater risk of stroke
• normal and pathophysiological haemodynamic changes in cerebrovascular disease.
• grading techniques and clinical trials related to grading of carotid artery disease (NASCET, ECST and asymptomatic carotid trials.

Clinical History, Examination and Management Options

• presenting signs and symptoms and identification of possible alternative diagnoses.
• range of medical, interventional and surgical management options (see medical and surgical management module for further details).
• how to recognise the clinical sequelae of the diagnosis.
• recognition of how diagnosis affects management pathway.
• the potential impact of cerebrovascular disease on the quality of life of the patient including long term complications.

Diagnostic Techniques

• diagnostic techniques used by clinical vascular scientists to assess the range of extracranial and intracranial disorders, including intimal thickening, stenosis, occlusion or dissection, both pre and post treatment.
• sources of error including contralateral occlusion.
• the appropriate technique for each patient.
• the role of duplex scanning within a multidisciplinary Transient Ischaemia Attack (TIA) clinic pathway.
• follow up and surveillance of carotid surgery including identification of patch disruption and infection.
• the complementary use of angiography, CT and MRA in the diagnosis and management.

Technical and clinical skills

By the end of this module, the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills including:

• performance of carotid and vertebral artery duplex scanning.
• assessment of carotid stents using B-mode, colour and spectral doppler to diagnosis post stenting stenosis.
• intra-operative and post -operative imaging of the extracranical carotid arteries post endarterectomy.
• assessment of intracranial and carotid arteries post thrombolysis.
• measure intima medial thickness from the common carotid artery and recognise sources of measurement error, rectifying them appropriately.
• operate non-imaging transcranial doppler unit to detect emboli.
• differentiate air and embolic signals.
• identify hyperperfusion or hypoperfusion from Doppler flow indices.
• optimise transcranial colour flow imaging on an ultrasound scanner using appropriate phased array transducer.
• identify collateral flow pathways in the Circle of Willis.
• recognise potential sources of error and artefact when performing transcranial doppler assessments or imaging.

By the end of this module, the Clinical Scientist in HSST will be expected to critically reflect and apply in practice, with respect to cerebrovascular assessment in a range of patients, clinical and communication skills to advise and  communicate effectively with patients, relevant clinicians and other healthcare professionals and will:

• take a clinical history and perform clinical assessment of patient.
• choose and provide expert opinion on the most appropriate technique/test for the clinical presentation.
• perform the ultrasound imaging or physiological measurement diagnostic test
• analyse and interpret physiological images and measurements.
• formulate and organise data (clinical history, clinical assessment, scientific results) to accurately report cases and emphasise the key findings and diagnoses.
• compare all data to justify and validate the conclusion.
• communicate with the multi-disciplinary team and participate in multi-disciplinary teams.
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.

Attitudes and behaviours

By the end of this module, the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations. They will also be expected to demonstrate the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:

• communicate appropriately with the patient and place the patient at the centre of care.
• prioritise the safety of the patient.
• consistently work to high standards of clinical practice applying knowledge and evidence, making decisions and evaluating the impact of those decisions.
• monitor, evaluate and maintain clinical practice standards.
• share data on clinical practice standards with service users and managers to encourage dialogue and debate.
• recognise the importance of the multidisciplinary clinical team and will take responsibility for ensuring appropriate and effective decision making processes are in place.
• support and contribute to the development of multidisciplinary clinical team working and work with the team to determine scientific service priorities.
• be committed to and support continuous improvement of vascular services, with particular reference to auditing practice, evidence based practice, innovation, new and improved technologies.