1. Carotid Stent Presentation
Presented By:
Rozita Hashemi, BSN, RN
Vangie Jimenez, MSN, RN
Elisa Rodriguez, BSN, RN

2. Carotid Artery Stenosis
CAS is defined as the narrowing of the carotid arteries that supply
blood to the brain, usually from plaque buildup (atherosclerosis) in the
inner lining of the artery.

3. Objectives Anatomy and physiology of carotid artery
Facts and statistics
Risk Factors
How to recognize signs of stroke
Carotid stent data for D10 East
CAS VS. CEA
Assessment post operative
Discharge planning and education
Best Practice in Medical Center and evidence based practice

4. Carotid Arteries
The common carotids split into the external artery, which supplies the face and other parts of the head, and the internal carotid artery which supplies the brain

5. Facts Causes ½ of the 7000,000 stokes each year
80% of the up to 500,000 Transient ischemic attacks
Stroke is the 3rd leading cause of death within western societies
Stroke is the leading cause of death and disability in the United States

6. Facts Continued
About 20% of all ischemic strokes are caused by atherosclerotic disease of the carotid artery.
Between 5% - 10% of Americans ages 65 and older have carotid arteries that have been significantly narrowed by plaque.
In many people , the atherosclerotic narrowing does not cause symptoms.

7. Risk Factors Smoking Sedentary lifestyle
High-fat, high-cholesterol diet
obesity (greater than 20% over the patient's ideal weight)
Diabetes or hyperinsulinemia (insulin resistance)
Hypertension
Uncontrolled stress and anger
LDL > 100 mg/dL
HDL < 50 mg/dL in women or < 40 mg/dL in men.
Male sex
Obesity

8. Signs and symptoms of stroke
Confusion
Difficulty speaking (slurred speech)
Difficulty swallowing
Blurry vision (or loss of vision)
Headache
Dizziness
Difficulty walking
Loss of balance and coordination
Limb weakness, numbness, or tingling.

9. Carotid Angioplasty

10. Dunn 10E Carotid Artery Stenting January-December 2007

11. Carotid Stents Data 2006- 13 out of 93 went to ICU/CCU

12. Comparison Data of Carotid Stent Complications

13. Treatment CEA (Carotid Endarterectomy) -the removal of plaque buildup
The treatment of choice for symptomatic Carotid artery stenosis
CAS (Carotid Artery Stenting)
-Minimizes restenosis and threatened vessel closure due to dissection
Study showed no significant difference between CAS and CEA in outcome measures death or ipsilaterial ischemic stroke at 30 days after procedure

14. Assessment Monitor vital signs Neurologic status Peripheral pulses
Monitor hemodynamic status, retroperitoneal hemorrhage, which needs immediate intervention.
Carefully watch the femoral site for hematoma formation, bruising, and pain.
Check peripheral pulses. A decrease in the intensity of the lower extremity peripheral pulses indicates falling blood volume and occlusion of the femoral artery caused by a developing hematoma.
Watch for blood within the peritoneal cavity, which causes severe back and flank pain. This needs immediate intervention.
Patients with CAD or age older than 77 years are at greater risk of experiencing hemodynamic instability.

15. Education after CAS Take Your Plavix and ASA as instructed
Monitor signs and symptoms of stroke
(report any suspected signs of stroke to your doctor immediately)
(long term follow up required)
Smoking cessation
Diet
Exercise

16. For Medicare Patients
The center for Medicare and medicaid Services recommended clinical use of carotid artery stenting only for patient with 70% or more symptomatic carotid artery stenosis and only if they are being treated in a facility with adequate expertise in diagnosis, treatment, and supportive care.

17. Best Practice
Research shows here in TMC patients report to Intensive care after Carotid stenting (via telephone)
In literature shows it is not necessary for patients to report to intensive care unit after carotid stent placement.

18. References
Gupta. R., Horowitz. M., Jovin. G. Tudor. (2005)Hemodynamic Instability After Carotid Artery Angioplasty and Stent Placement: a Review of the Literature. Retrieved February 15, 2008.
Sullivan, T. (2005). Choice between Carotid Endarterectomy and Carotid Angioplasty and Stenting. Retrived February 15,2008.
Kastup.A, Groschel. K. (2005) Treatment and symptomatic and Asymptomatic Internal Carotid Artery Stenossis in Older Adults.
Greelish. J, Mohler.R.E., Fairman.M.R, (2007) Carotid Angioplasty and stenting.
Flach.H.Zwenneke, Ouhlous.M., Hendriks.M.J.,CanSambeek.M., Veenland.F.J., Koudstaat.J.P.,Van Dijk.C.L., Can Der Lught.A. (2004). Cerebral Ischemia After Carotid Intervention.
Screening to prevent stroke. (December 2007). Retrieved from March 20, 2008 from
St. Lukes RN, personal communication, February 15, 2008).
Memorial Herman Medical Center RN, Personal communication, February 15, 2008).