Advertisement

Management of Patient Undergoing Carotid Stenting

  • Shilpa RaoEmail author
Chapter
  • 26 Downloads

Abstract

Carotid artery atherosclerosis and the resulting stenosis is one of the major and important causes of stroke. Early recognition of symptoms and treatment is appropriate to minimize long-term morbidity. Carotid artery stenting is one of the surgical techniques employed to treat this condition. This problem-based learning discussion highlights the high-risk patient population, appropriate preoperative risk stratification, and intraoperative neuromonitoring and anesthetic considerations for carotid artery stenting.

Keywords

Carotid artery stenosis Carotid artery stenting Preoperative cardiac risk stratification Anesthetic goals for carotid artery stenting Neuromonitoring techniques 

References

  1. 1.
    Fleisher LA, et al. 2014 ACC/AHA Perioperative Guideline: Executive Summary.Google Scholar
  2. 2.
    Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK, Ludwig LE, Pedan A, Goldman L. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–9.CrossRefGoogle Scholar
  3. 3.
    Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 2005;173(6):627–34.CrossRefGoogle Scholar
  4. 4.
    Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58:e44–122.CrossRefGoogle Scholar
  5. 5.
    Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK, et al. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011;54(3):e1–31.CrossRefGoogle Scholar
  6. 6.
    Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325(7):445–53.CrossRefGoogle Scholar
  7. 7.
    Kernan WN, Ovbiagele B, Black HR, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 45(7):2160–236.Google Scholar
  8. 8.
    Bonati LH, Gregson J, Dobson J, et al. Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the international carotid stenting study (ICSS): secondary analysis of a randomised trial. Lancet Neurol. 2018;17:587.CrossRefGoogle Scholar
  9. 9.
    Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2007;116:e418–500.PubMedGoogle Scholar
  10. 10.
    Leichtle SW, Mouawad NJ, Welch K, et al. Outcomes of carotid endarterectomy under general and regional anesthesia from the American College of Surgeons’ National Surgical Quality Improvement Program. J Vasc Surg. 2012;56:81.CrossRefGoogle Scholar
  11. 11.
    Gough MJ, Bonham A, Horrocks M, Colam B, Lewis SC, Rothwell PM, et al. GALA: an international multicentre randomised trial comparing general anesthesia versus local anesthesia for carotid surgery. Trials. 2008;9:28.CrossRefGoogle Scholar
  12. 12.
    Kirchheim HR. Systemic arterial baroreceptor reflexes. Physiol Rev. 1976;56:100–77.CrossRefGoogle Scholar
  13. 13.
    Ladak N, Thompson J. General or local anaesthesia for carotid endarterectomy? Contin Educ Anaesth Crit Care Pain. 2012;12(2):92–6.CrossRefGoogle Scholar
  14. 14.
    Wu TY, Anderson NE, Barber PA. Neurological complications of carotid revascularisation. J Neurol Neurosurg Psychiatry. 2012;83:543.CrossRefGoogle Scholar
  15. 15.
    Hill MD, Brooks W, Mackey A, et al. Stroke after carotid stenting and endarterectomy in the carotid revascularization Endarterectomy versus stenting trial (CREST). Circulation. 2012;126:3054.CrossRefGoogle Scholar
  16. 16.
    Boulanger M, Camelière L, Felgueiras R, et al. Periprocedural myocardial infarction after carotid Endarterectomy and stenting: systematic review and meta-analysis. Stroke. 2015;46:2843.CrossRefGoogle Scholar
  17. 17.
    Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11.CrossRefGoogle Scholar
  18. 18.
    Casserly IP, Abou-Chebl A, Fathi RB, et al. Slow-flow phenomenon during carotid artery intervention with embolic protection devices: predictors and clinical outcome. J Am Coll Cardiol. 2005;46:1466.CrossRefGoogle Scholar
  19. 19.
    Stoneham MD, Thompson JP. Arterial pressure management and carotid endarterectomy. Br J Anaesth. 2009;102:442–52.CrossRefGoogle Scholar
  20. 20.

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Division of Neuroanesthesiology, Department of AnesthesiologyYale School of Medicine, Yale New Haven HospitalNew HavenUSA

Personalised recommendations