By Thomas Forbes
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Additional info for Angioplasty, Various Techniques and Challenges in Treatment of Congenital and Acquired Vascular Stenoses
Despite the lack of a precise BP target, lowering systolic BP to at least 20% to 30% below baseline values seems critical, particularly in patients with critical stenosis and above all in patients with impaired CVR. Labetalol and clonidine seem to be the most appropriate drugs for BP control in this context. To determine when discharge is safe after CAS, patients should be divided into two groups. One group includes asymptomatic, hemodynamically stable patients with low comorbidity who could be discharged after 6 h of observation, according to some authors.
J Med Imaging Radiat Oncol. 2009 Feb;53(1):81-6. ; Matsushima, S & Taki, W. Periprocedural hemodynamic instability with carotid angioplasty and stenting. Surg Neurol. ; Stingele, R & Jansen, O. Complication rate in unprotected carotid artery stenting with closed-cell stents. ; Valentine, RJ & Clagett, GP. Intracranial hemorrhage after carotid endarterectomy and carotid stenting in the United States in 2005. J Vasc Surg. 2009 Mar;49 (3): 623-8. Takolander RJ, Bergqvist D. Intracerebral hemorrhage after internal carotid endarterectomy.
Likewise, TCD monitoring during CAS and probably in the hours after the procedure can help select high risk patients (Dalman et al, 1999; Fujimoto et al, 2004; Kablak et al, 2010; Jansen et al, 1994; Iwata et al, 2011; Sfyroeras et al, 2009). Strict control of hypertension is one of the preventive measures that has received the most attention. Most Investigators recommend strict control of BP in the postoperative period to prevent ICH after CEA (Ahn et al, 1989; Bernstein et al, 1984; Bove et al, 1979; Buhk et al, 2006; Hosoda et al, 2001; Ko et al, 2005; Roh et al, 2005; Safian et al, 2006; Tang et al, 2008) and after CAS, as we will see below.
Angioplasty, Various Techniques and Challenges in Treatment of Congenital and Acquired Vascular Stenoses by Thomas Forbes
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