ABSTRACT

This chapter aims to discuss the perioperative management of patients undergoing carotid stent placement and other brachiocephalic interventions. It describes the strategies for anticoagulation, treatment of procedural hemodynamic changes, and access management. The arterial system can almost always be accessed through the femoral arteries. The arch aortogram must be carefully studied to evaluate the potential pathways from the brachial artery to the target carotid artery. The arch aorto-gram is studied to pick the route with the least acute angle of approach. The distance between the left common carotid artery and the innominate artery or the left subclavian along the arch may be very short. Most of the time, however, carotid stent recipients are patients with multiple comorbidities who were not good candidates for endarterectomy. In the setting of an investigational procedure, it is probably best to monitor the patients for 24 hour each until more is known.