Carotid interventions by Peter Schneider, Todd Bohannon, Michael Silva

By Peter Schneider, Todd Bohannon, Michael Silva

From sufferer choice and tracking to follow-up care, Carotid Interventions is the 1st resource to provide a pragmatic how-to method of carotid angioplasty and stenting-providing maneuvers and techniques for tough events, in addition to step by step counsel on particular surgeries, gear choice and instrumentation, defense units, and room/facility format.

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3). The window for catheter manipulation decreases as the two parallel lines become closer. This is a good conceptual exercise, but the location of the cranial-most point in the arch is not of direct value in the assessment process. This point does not influence guidewire, catheter, or sheath passage. It is the fulcrum over which these tools must work that determines the conduct of the case. The ‘‘surf and turf’’ classification provides a system for rapid but specific assessment without complicated measurements.

Examination of the patient should include a neurological exam and an assessment of the vascular system. Specifically, a complete examination of the vasculature should include bilateral brachial blood pressures, palpation of pulses at the carotid, subclavian, axillary, brachial, and superficial temporal positions. Any difference in brachial blood 36 Schneider Fig. 1 Aortic arch configurations influence carotid arteriography: using the ‘‘surf and turf’’ classification. (A) This is a normal arch. ( B) Some patients have an elongated arch that pushes the origins of the branch vessels down into the chest and causes more acute curvature of the distal arch.

In some instances, additional atropine beyond the initial dose may be needed and should be available. Pacing leads should be accessible in case the patient proves unresponsive to medical therapy for bradycardia. Hypertension is frequent in this patient population and should be treated promptly to limit the potential for intracranial hemorrhage. Continuous infusion of nitroglycerin is helpful for this issue as it can be rapidly titrated up or down to control blood pressure, and this agent will help with anginal symptoms in patients as well.

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