A carotid artery stent is a tiny, flexible, metal mesh tube developed to help keep the carotid artery open

VASCULAR SURGERY WHAT IS A CAROTID ARTERY STENT? A carotid artery stent is a tiny, flexible, metal mesh tube developed to help keep the carotid artery...
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VASCULAR SURGERY WHAT IS A CAROTID ARTERY STENT? A carotid artery stent is a tiny, flexible, metal mesh tube developed to help keep the carotid artery open. Stenting is a treatment done through or inside the blood vessels. A stent is placed in the narrowed artery. Using stents to treat carotid artery disease is now an option for some patients. The treatment is usually done under local anesthetic given at the arterial site (usually the femoral artery at the groin). Access to the artery is through a tube called a sheath. Sometimes, mild sedation may be administered.

This gives you general information about your Carotid stenting procedure, your admission and stay at the hospital. If you have any questions after reading this information, please contact your physician. Your brain is the control center of your body. To work efficiently, your brain needs a constant supply of oxygen and nutrient rich blood. Your brain receives its blood supply via four major arteries (a left and right carotid artery and a left and right vertebral artery). Your medical condition will determine which artery will be treated. Many patients have atherosclerotic disease, which is a build up of plaque (cholesterol) in the artery. This will cause narrowing of the artery.

HOW LONG WILL THE STENT STAY IN THE ARTERY? It is implanted permanently. The inner lining of the blood vessel will quickly grow back to cover the stent.

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HOW TO PREPARE FOR YOUR HOSPITAL STAY Before coming to the hospital, consider the following: – You will be asked by your doctor to take anti-platelet medication (such as aspirin (ASA) and Clopidogrel (Plavix ™) for a few days before and the day of your stent procedure. – Bring all of your medications into hospital with you – Your hospital stay will be 1 to 2 days. – Plan for house sitting, child or pet care if needed. – Do not bring valuables (jewelry, money, etc.) into the hospital. – Arrange for someone to drive you home.

HOW TO PREPARE FOR YOUR RETURN HOME Before coming into hospital, consider the following: – Check with your doctor about possible restrictions on your activity. – You may find lifting objects (groceries or young children) and doing housework uncomfortable. You may need someone to help with chores. We suggest you arrange help with groceries and housework for the first week after your procedure. – Arrange for a family member or friend to help you at home. – You will be discharged at 9 o’clock in the morning. – If there are special arrangements required for your return home, please tell a member of your Patient Care Team.

THE NIGHT BEFORE YOUR PROCEDURE The night before your procedure you can eat and drink until midnight. After midnight, you can no longer eat solid food or drink alcohol. You may drink clear fluids (water/apple juice) until 3 hours before your operation. You may continue to take your normal medications with sips of water unless told not to by your doctor. Before your procedure, discuss all your medications with your doctor. Remember, a good night’s sleep is important in preparing for the day ahead.

AT THE HOSPITAL Please arrive at the hospital’s Admitting Department on the date and time given to you. You will be directed to the Patient Care Unit where your nursing care begins. Your nurse

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starts an intravenous (IV) line through which you are given fluids and medications as needed. PROCEDURE You will have a catheter (sheath) placed by the doctor into the femoral artery in your groin. You will be asked to keep this leg straight during the procedure and for approximately 2 to 6 hours after. The procedure uses a stent, which is a flexible metal tube, to open partially blocked arteries and to hold the plaque against the artery wall, allowing better blood flow through to your brain. The stent is introduced into the narrowed blood vessels after an embolic protection device has been placed beyond the narrowed area of the artery. An embolic protection device is a filter designed to catch any pieces of plaque or other particles that may be released during the procedure, while still allowing flow of blood through the artery. The physician maneuvers the stent on a catheter in the vessel and positions the stent across the narrowed area.

FOLLOWING THE STENT PROCEDURE Once the stent procedure is completed, you will be transferred from a stretcher to your bed and moved to the recovery unit (PARR) for approximately 6 hours. The sheath will be removed shortly after completion of the procedure. When removed, pressure is applied to the site to prevent bleeding and excessive bruising in your groin and thigh. Once you return to your patient care unit, you may be asked to remain in bed overnight, or as directed by your physician. Your nurse will observe you closely after your procedure. The nurse will check your vital signs including your level of consciousness and other neurological vital signs and the groin site for several hours. You will be allowed to eat and drink shortly after the procedure. While in the hospital, please inform the health care team if you feel any of the following symptoms: – Dizziness – Severe headache – Blurring or loss of vision – Sudden weakness – Difficulty swallowing or speaking – Bleeding or pain at the puncture site – Pain or numbness of the leg 3

MEDICATIONS Your doctor will prescribe blood thinners known as anticoagulants and/or antiplatelet medications. These drugs lower the risk of blood clots. Risk factor management (such as smoking, lipid lowering, exercise, and weight control) should be discussed with your physician.

HOSPITAL DISCHARGE You should be ready to go home by the first or second day following your procedure. Please speak with your physician regarding any restrictions you may have regarding activity. Shower (rather than tub bath) until the groin area is completely healed). Do not have neck manipulation/massages by a chiropractor or have any pressure (e.g. tight collar or neck ties) around your neck until discussed with your physician. You may need help with some of your daily activities for a short period of time. Discharge time from hospital is at 9:00 a.m. Some bruising around the groin and thigh is normal and to be expected. Please contact your physician if you notice: – Any new bruising or swelling – Bruising or swelling that is increasing – Dizziness – Severe headache – Blurring or loss of vision – Sudden weakness – Difficulty swallowing or speaking – Bleeding or pain at the puncture site – Pain or numbness of the leg

WILL I HAVE TO TAKE MEDICINE? Since a stent has been implanted into your carotid artery, treatment with antiplatelet medications (to stop blood clots) is essential. The antiplatelet medications are Aspirin ® (ASA) and Clopidogrel (Plavix®). Carefully follow the directions your doctor gives you. Even if you feel fine, you will need to pay careful attention to your medication schedule. Over time, your doctor may reduce your medication. You should never change them yourself. You will be given a wallet size card and bracelet to identify that you are on Plavix®. Please be sure you wear the bracelet and keep the card in your wallet at all times.

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WILL I NEED A SPECIAL PRESCRIPTION? If your doctor has prescribed Clopidorgrel (Plavix®) be sure to fill your prescription right away. Do not miss any doses. Plavix®, together with Aspirin®, help to protect against blood clots forming in a new stent. Blood clots in a new stent can cause a stroke. If you have been prescribed Plavix® you will need to take it concurrently with Aspirin® for a minimum of 30 days and possibly longer as directed by your physician. You may be eligible for Pharmacare benefits, which may cover or partially cover your prescription costs. This coverage depends upon your deductible, determined from your net income. British Columbia residents must register and file a statement of net income with Pharmacare to receive benefits. You may contact Pharmacare toll free in BC by calling Health Insurance BC at 1-800663-7100 for further information. If you are eligible for benefits, Pharmacare will only cover (or partially cover) the costs of Clopidogrel (Plavix®) in special circumstances. In these special circumstances your vascular surgeon/radiologist or hospital pharmacist must seek Pharmacare approval for coverage. If you meet the criteria for special approval, we have obtained this for you. If you don't meet the criteria or have not met your yearly Pharmacare deductible you will have to pay the full cost of your Clopidogrel (Plavix®) prescription.

Take this pamphlet with you to get your prescriptions filled and show it to your pharmacist. Pharmacist: We have sent a FAX to Pharmacare seeking special authority coverage on an urgent basis or indefinite approval for patients who quality for long-term Plavix® for therapeutic failure of aspirin.

Reginald E. Smith, Pharm.D. Cardiac Services, Royal Jubilee Hospital Victoria, B.C. (250) 370-8000 Ext 2418

 Adapted from Vancouver Coastal Health. 5

MAY 2007

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