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44024 - CAROTID ARTERY ANGIOPLASTY AND STENTING:ANESTHETIC IMPLICATIONS

¹ Dept of Anesthesia, Toronto Western Hospital, Toronto, ON, Canada
² Dept of Anesthesia, Toronto Western Hospital
³ Dept of Anesthesia, Toronto Western Hospital
⁴ Toronto Western Hospital

Abstract

INTRODUCTION: Patients with carotid artery occlusive disease frequently have other co morbidities, especially cardiac disease. A newer option for treatment is carotid angioplasty and stenting (CAS), which has been shown to result in lower incidence of stroke and myocardial infraction, but may have a high incidence of hemodynamic changes during the procedure. (1,2) We reviewed the anesthetic management and the incidence of cardiovascular and other complications during and after treatment with CAS.

METHODS: After ethics board approval, medical records of all patients who had CAS over an 18-month period were reviewed. Data collected included demographics, preoperative co morbidities, anesthetic management and the incidence of complications during and post CAS.

RESULTS: 29 patients were reviewed; mean age (±SD) was 71±11 yr, weight 76± 11 kg, 16 male, 13 female and median ASA 3 (range 2–4). 21 patients (72%) presented with TIA, remainder with stroke. Pre-procedure medical co morbidities were: coronary artery disease 31%, hypertension 55%, diabetes 27% and peripheral vascular disease 6%. Anesthesia was conscious sedation in 27 patients (propofol 86±94mg (n=23), fentanyl 102±85µg (n=23), midazolam 2.4±1.4mg (n=25). Two patients had general anesthesia as they also planned treatment of intracranial lesions. Monitoring included ECG, non-invasive blood pressure, PETCO2, and SpO2. A defibrillator/pacemaker was present in the room for all patients but not attached to any patient. Prophylactic vagolytic agents were used in 72%, (glycopyrrolate 0.29±0.1mg (n=20) and atropine 0.6mg (n=1). There were no incidences of myocardial ischemia. One patient developed hyperperfusion syndrome post procedure. Complications are shown in Table.

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This Article Abstract Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chakravarti, S. Articles by Zhang, W Search for Related Content PubMed Articles by Chakravarti, S. Articles by Zhang, W