[Nursing Care of Patients With Carotid Artery Stenosis Who Receive Carotid Artery Stent].

Atherosclerosis, a major cause of carotid artery stenosis, has a high correlation to stroke, which may induce transient ischemic attack (TIA) and/or permanent brain damage. The main treatment of carotid artery stenosis includes medication, carotid endarterectomy (CEA), and carotid artery stenting (CAS). However, when artery stenosis becomes severe, CEA or CAS is the most-often recommended intervention. CAS, a type of revascularization, is considered less invasive than CEA and is associated with a higher successful rate. CAS not only treats carotid stenosis effectively and reduces the incidence of stroke and myocardial infarction but also may increase the survival rate. Because CAS may lead to in-stent restenosis, an eluting stent has been developed to prevent this adverse event. However, the effectiveness of the eluting stent has yet to be adequately verified. As patients who receive CAS remain at risk of recurrent stroke, intravascular restenosis, TIA, and mortality, post-procedure medical and nursing care for this population must be appropriately applied in order to maximize the rate of long-term success. Therefore, we recommend that clinical physicians and nurses regularly evaluate and monitor post-CAS patients in order to prevent complications. Moreover, they should educate patients before discharge on post-CAS wound care and medicine-taking regimens as well as on the importance of smoking cessation, controlling blood sugar and blood pressure, exercising regularly, reducing body weight, maintaining a healthy diet, and controlling the risk factors of atherosclerosis in order to prevent the recurrence of complications.

Limb shaking. descripción de un caso desde la perspectiva / Limb Shaking: description of a case from a nursing perspective

Introducción. El limb shaking, descrito por Miller Fisher en 1962, se caracteriza por movimientos involuntarios, irregulares y estereotipados de un hemicuerpo desencadenados por la hipoperfusión hemisférica contralateral. Se asocia a una oclusión o estenosis crítica de la arteria carótida interna (ACI) extracraneal contralateral a los movimientos y a una pobre circulación colateral. Esto causa una isquemia que da lugar a las manifestaciones clínicas típicas de un ictus y estos movimientos anormales. Objetivo. Describir el caso clínico de un paciente con limb shaking. Descripción del caso. Varón de 59 años, con factores de riesgo cardiovascular, que acude a Urgencias por un cuadro súbito de afasia motora y pérdida de fuerza en extremidades derechas de predominio braquial distal. Ingresa en la Unidad de Ictus para monitorización neurológica y hemodinámica, donde, coincidiendo con el inicio de la sedestación, presenta estos movimientos involuntarios. Resultados. Las pruebas diagnósticas confirman un ictus isquémico cortical frontal izquierdo. El electroencefalograma muestra una actividad bioeléctrica de fondo normal. Es en la angio-RMN y la arteriografía donde se halla una estenosis crítica de la ACI izquierda. Discusión. Se establece el diagnóstico de limb shaking de acuerdo con los hallazgos del examen clínico y las pruebas complementarias, que confirman la presencia de una pseudooclusión de la ACI izquierda y la refractariedad al tratamiento antiepiléptico. Conclusión. El limb shaking es un síndrome raro, que debe reconocerse y diferenciarse precozmente de otros procesos para tratarlo de forma adecuada. El tratamiento está destinado a restaurar el flujo sanguíneo cerebral, mediante la revascularización quirúrgica o endovascular del hemisferio isquémico (AU)

Introduction. Limb shaking, which was described by Miller Fisher in 1962, is characterized by involuntary, irregular, stereotyped a hemibody triggered by the contralateral hemisphere hypoperfusion. It is associated with an occlusion or stenosis preoclusive of the extracranial internal carotid artery (ICA) contralateral to the movements, and poor circulation contralateral. This causes ischemia resulting in typical clinical manifestations of stroke and these abnormal movements. Objective. To describe a case of limb shaking. Materials and methods. 59 years old man, with cardiovascular risk factors, who go to the Emergency room with symptoms and motor dysphasia and sudden loss of strength in right limbs, with distal brachial predominance. Admitted to Stroke Unit for neurological and hemodynamic monitoring, which coincides with the beginning of the sitting have an episode of these involuntary movements. Results. Diagnostic tests confirm a left frontal cortical ischemic stroke. The EEG shows a normal background bioelectric activity. The angio-MRI and angiography showed a left ICA pseudoocclusion Discussion. A diagnosis of limb shaking based in the clinical examination and additional tests, which confirm the finding of a left ICA pseudo-occlusion and refractory to antiepileptic treatment. Conclusion. The limb shaking is a rare syndrome, which must be recognized and differentiated early from other processes to treat it properly. Treatment is aimed at restoring cerebral blood flow through the ischemic hemisphere revascularization (AU)

Carotid artery endarterectomy: a multidisciplinary approach to improving resource utilization and quality assurance.

An estimated 780,000 people in the United States have a stroke each year. Carotid endarterectomy (CEA) is the most frequently performed surgical procedure to prevent the occurrence of stroke. Over the past several years, physicians, nurses, and allied healthcare workers have been challenged to perform this operation in a cost-effective manner without compromising clinical outcomes. At Maine Medical Center (MMC), Portland, Maine, an average of 250 CEAs are performed annually. As part of a quality-assurance initiative, MMC key stakeholders redesigned the care of patients undergoing CEA surgery. A critical pathway supported by a computerized order set was implemented; standardized discharge instructions and a patient teaching brochure were developed. A patient flow algorithm allowing select patients to bypass the intermediate care unit and transfer directly from the post-anesthesia care unit to a non-telemetry surgical bed was instituted. From January 1, 2010, to December 31, 2011, 467 chart audits were completed on 100% of CEA surgeries (cases with concomitant procedures excluded) using the Vascular Study Group of New England data collection form. Data analyzed supports the practice changes that were instituted. Allowing patients to be admitted to a non-telemetry surgical unit following CEA has resulted in significant cost savings and increased the availability of intermediate care beds to higher acuity patients without negatively affecting patient outcomes.

Carotid angioplasty and stenting in carotid artery stenosis: neuroscience nursing implications.

Stenosis of the internal carotid artery due to atherosclerosis can cause embolic stroke or cerebral ischemia, both of which may result in significant morbidity, mortality, and long-term disability. Although the endovascular technique with balloons and stents to relieve arterial (i.e., coronary) stenosis has allowed a nonsurgical approach to the management of atherosclerotic disease for many years, its use in carotid vessels has only recently gained popularity. In addition, improvements in endovascular access systems have extended the use of carotid angioplasty and stenting (CAS), especially since the advent of cerebral emboli protection devices. Nowadays, CAS is emerging as an intervention for high-risk surgical patients with high-grade carotid artery stenosis. Nursing care of these patients before, during, and after CAS is challenging. Patients and family need to be educated about the aim and consequences of the procedure and its complications. To care for these patients, the nurse must understand the techniques of CAS. The purpose of this article was briefly to review the etiology of stroke, the current treatments to relieve carotid stenosis, and the basic steps of CAS. The nursing management throughout the procedure, the patient preparation before the procedure, and most importantly, the postprocedure nursing care are discussed.

Carotid stents: is the gold standard ready for change?

Carotid artery stenting is emerging as an intervention for high-risk nonsurgical patients with high-grade symptomatic carotid artery stenosis. The purpose of this article is to inform advanced practice nurses about research findings related to carotid endarterectomy and carotid artery stenting. This overview of carotid angioplasty and stenting includes complications and guidelines for preprocedural, periprocedural, and postprocedural care. Standards of practice for managing carotid artery disease are highlighted with emphasis on primary and secondary prevention.

Carotid artery stenosis and endarterectomy.

This article reviews the disease process of carotid artery stenosis, its symptomatology, and prognosis for progression to ischemic stroke. Indications for both medical and surgical treatment are reviewed as is criteria for surgical categorization as specified by the American Heart Association guidelines for carotid endarterectomy. Although diagnostic testing, medical treatment and alternative therapy options of angioplasty, stenting and thrombolysis are presented, a thorough overview of the surgical procedure of carotid endarterectomy is the major focus of discussion, as it remains the "gold standard" of treatment for severe carotid artery stenosis.

Managing patients with carotid stenosis.

Patients with carotid stenosis present multiple challenges to the medical-surgical nurse case manager. Implementing a defined critical pathway for the patient undergoing a carotid endarterectomy can result in quality cost-effective care, fewer complications, and less possibility of future stroke.