ABSTRACT
This chapter describes one method for balloon angioplasty and stent placement in the treatment of carotid bifurcation occlusive disease. The procedure is performed under local anesthesia with minimal or no sedation to facilitate continuous neurological monitoring. An arterial line is placed for continuous pressure monitoring and EKG leads for cardiac monitoring. Techniques such as squeezing a rubber doll aids in simple and effective neurological monitoring during the procedure. Selective cannulation of the arch vessels are technically the most challenging and critical portion of carotid angioplasty and stenting (CAS) procedures. Avoiding extreme oversizing of the stents helps to decrease the incidence of post-CAS bradycardia and hypotension. The presence of significant hypotension in the absence of bradycardia is unusual in the immediate postprocedure period, retroperitoneal bleed related to access site problems, should also be excluded as the cause.
