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

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.

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

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

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

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.

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

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.

Carotid Angioplasty

Dunn 10E Carotid Artery Stenting January-December 2007

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

Comparison Data of Carotid Stent Complications

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

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.

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

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.

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.

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 www.health.harvard.edu. St. Lukes RN, personal communication, February 15, 2008). Memorial Herman Medical Center RN, Personal communication, February 15, 2008).