Question

Discuss patient selection criteria and pre-procedure workup for carotid stenting.

Hint:

Careful patient selection and thorough pre-procedure workup are essential for a successful carotid stenting procedure and minimizing complications.

Answer 1

Patient selection for carotid stenting involves assessing various clinical and imaging factors to ensure that the procedure is appropriate for the individual patient.
Step 1: Patient Selection Criteria:
1. Indications: Carotid stenting is typically indicated for patients with symptomatic carotid artery stenosis (≥50%) or asymptomatic stenosis (≥80%) who are at high risk for carotid endarterectomy.
2. Age and Medical Conditions: Patients should be relatively healthy with a life expectancy greater than 5 years and have no contraindications to antiplatelet therapy. Age and comorbidities such as heart disease or renal failure should be considered.
3. Anatomical Considerations: Imaging studies, such as CT angiography or digital subtraction angiography, are used to evaluate the location, length, and severity of the stenosis, as well as the presence of tortuous or heavily calcified vessels.
Step 2: Pre-procedure Workup:
1. Assessment of Cerebral Blood Flow: Transcranial Doppler ultrasound is used to assess cerebral blood flow and determine if there is a risk of ischemic events.
2. Cardiac Assessment: A thorough cardiac evaluation, including ECG and echocardiography, is performed to assess the patient's cardiac status and risk during the procedure.
3. Antiplatelet Therapy: Dual antiplatelet therapy (aspirin and clopidogrel) is usually started prior to the procedure to reduce the risk of thromboembolic events.