Page 78 - Critical Care Notes

4223_Tab02_045-106 29/08/14 10:00 AM Page 72

CV
Other Complications
■ Infection
■ CAD
■ GI complications related to medications
Carotid Endarterectomy (CE)
CE is a surgical procedure to remove plaque material from inside the carotid
artery that improves the carotid luminal diameter, allows adequate blood flow,
and therefore prevents stroke. The procedure is indicated in symptomatic
patients with carotid-territory TIA or minor strokes who have carotid artery
stenosis of 70%–99%.
Pathophysiology of the Disease Process Leading to CE
Surgery is performed on patients with symptomatic carotid artery stenosis.
Fatty streaks are deposited in arterial intima → stimulates inflammatory
response that causes proliferation → blood vessels forming fibrous caps →
deposit builds up as atheromas or plaques → plaques build up, causing blood
flow obstruction.
Clinical Presentation
■ Signs and symptoms of TIA or stroke. Refer to Neuro Tab.
■ Sudden dysphagia.
■ Dizziness.
■ Lightheadedness.
Diagnostic Tests
■ Ultrasound of carotid artery
■ Computed tomographic angiography (CTA)
■ Magnetic resonance angiography (MRA)
■ Contrast-enhanced MRA (CEMRA)
Management of Clinical Condition
■ Assess surgical site for bleeding.
■ Perform frequent neurological checks.
■ Administer antihypertensive medications. Maintain SBP between 120 and
170 mm Hg.
■ Administer statins.
■ Administer antiplatelet agents.
■ Administer aspirin (81–325 mg) before and after surgery.
■ Monitor for difficulty speaking, swallowing, or breathing. Report immediately.

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