ABSTRACT
This chapter provides an algorithm for recognizing and managing an acute neurological event during or immediately after carotid stent placement. A major concern about carotid stenting that has delayed its development is the possibility of cerebral emboli as a result of endoluminal manipulation of the carotid bifurcation. When an acute neurological deficit occurs during carotid arteriography or carotid stent placement, the likely cause is the embolization of dislodged atherosclerotic plaque or catheter-generated thrombus. When a neurological event occurs during the procedure, it may present as a focal motor deficit, seizure, hemineglect, or a decreased level of consciousness. Although neurorescue techniques have potential benefits in patients with new neurological deficits during carotid stenting, it is not the standard of care and may turn out to have worse results than other options in some patients.
