Routine Postprocedural Care

It is recommended that the patient remain heparinized overnight, with international normalised ratios of approximately 2.0 to 2.5 to protect against clot formation along the stent. To ensure that the patient does not bleed from the access site, either the sheath should be secured into place or a closure device should be used. If it is decided that the sheath stay in place overnight, the patient must remain supine and the sheath must be monitored and kept open throughout the period of risk. Patients who still have a sheath in place can be placed in a reverse Trendelenburg position, so that they have some ability to eat and socialize while in the unit.

Patients should remain on aspirin and clopidogrel for 4 to 8 weeks to prevent the development of in-stent thrombosis. Dose variation is usually determined by the level of medical risk to the patient. Usually, patients who develop carotid disease also have vascular disease in other territories; therefore, aspirin is usually recommended indefinitely, unless it is contraindicated by some other factor.

Post procedure, the patient should recover in an intensive care unit setting, preferably a unit dedicated to neurosciences, as frequent neurologic checks are recommended no less than once every 2 hr. Groin checks are frequent (every 15 min for the first hour, and once per hour thereafter).

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