Do you use an aline for carotid stent?
Do you use an aline for carotid stent?
Do you use an aline for carotid stent?
I do. We have both neurosurgery and vascular surgery doing carotids at our hospital.
Neurosurgey does them under general anesthesia with both SSEP and intraoperative transcranial doppler monitoring for the cross clamp phase and emboli monitoring. These are typically patients with reasonably severe bilateral disease, and also some component of cerebrovascular stenosis. There's a trial clamp of the carotid, and if ipsilateral TCD velocity of the MCA drops more than 50%, we at least ensure the blood pressure is maintained at the patient's baseline. Then If there's any change in SSEP signals during cross clamp, I incrementally raise the BP, hoping to improve collateral flow. If unable to normalize the SSEPs, then the surgeons usually shunt.
The vascular surgeon I work with prefers awake patients. Not everyone gets an aline, usually however, those with fairly high baseline BP will get one. If the patient begins to get a little altered or has focal signs during the cross clamp, assuming BP is somewhere near baseline, I incrementally increase the BP and try to normalize the neural exam. If we can't restore function, they shunt or sometimes just work quickly when it's a short segment of stenosis.
Watch out for bradycardia as the stent is deployed. I give glyco preemptively. Plenty of cases that have arrested 2/2 Brady>asystole. I put in an a-line cuz I know I'll never regret it.
Really? Dude... a-lines do not take 30-40 min. Use an USD and get it on your first stick if you feel it will take you that long. Bradycardia and asystole is for real in these cases. I can't remember the last time an Aline has taken me more than 5 min. No offense idio.
Risk vs benefit.
Really? Dude... a-lines do not take 30-40 min. Use an USD and get it on your first stick if you feel it will take you that long. Bradycardia and asystole is for real in these cases. I can't remember the last time an Aline has taken me more than 5 min. No offense idio.
Risk vs benefit.
sorry, man, i didnt know you werent up for a discussion, and obviously took my joke the wrong way. ill keep any more comments to myself.