Full sterile precautions should be maintained throughout the procedure as with any invasive procedure. For the transcarotid approach, the patient should be supine with a shoulder roll placed underneath the shoulders and the neck turned to the opposite side. All patients should be asked about aspirin and Plavix use in the preoperative holding area.įor the transfemoral approach, the patient should be supine and the neck should be turned to the opposite side. Patients should be on aspirin and Plavix preoperatively, and these should be continued in the postoperative period. It is also prudent to have an arterial line in place for invasive hemodynamic monitoring during the procedure. Anesthesia personnel should have vasoactive medications available to treat such hemodynamically significant changes. As with CEA, CAS can cause dramatic changes in the patient’s hemodynamics, leading to hypotension or bradycardia. Regardless of the approach, patients should be closely monitored during the procedure. If general anesthesia is employed, use of intraoperative EEG/brain mapping should be considered. For the transcarotid approach, either local anesthesia with sedation or general anesthesia may be employed. In case of a transfemoral approach, most physicians choose to perform CAS under local anesthesia with or without sedation to monitor the patient’s neurologic status. The angulation, as related to the type of aortic arch, has important implications for CAS. For a type 3 aortic arch, the origins of all great vessels fall within the third parallel line.
If the origins of all great vessels fall within the second parallel line, this is considered a type 2 aortic arch. For a type 1 arch, all great vessels originate close to the imaginary horizontal line drawn through the top of the aortic arch. To simplify, an imaginary horizontal line is drawn through the top of the aortic arch, and imaginary parallel lines marking the origins of the great vessels coming off the arch are drawn for comparison. The aortic arch can be divided into three anatomic types. This is helpful for the maintenance of blood flow through collateral circulation in case either artery becomes occluded. The internal and external carotid arteries form collaterals at several locations. The internal carotid artery provides blood to the brain while the external carotid artery provides blood to the face, scalp and the neck. It divides into internal and external carotid arteries. For information regarding the process of revising the Standards or 60-day public comment period, review the IAC Accreditation Program Policies & Procedures, Section 1: Changes to the Standards.The common carotid artery arises from the aortic arch (left) or the brachiocephalic trunk (right). Additionally, applicant facilities are notified via e-mail when revisions to the Standards & Guidelines are available for public comment. Learn more about the IAC Carotid Stenting accreditation program or access other resources at /carotid.Ĭurrent proposed revisions to any of the Standards above can be found on the IAC public comment period page at /comment-period when available. Standards are in regular typeface in outline form, but guidelines are in italic typeface and in narrative form.Īpplicant facilities must reference the current published version of the Standards when applying for first-time accreditation or reaccreditation. Guidelines can assist with interpretation of the Standards. Guidelines are descriptions, examples or recommendations that elaborate on Standards, however, guidelines are not requirements.
Additionally, facilities must also follow laws relating to licensed scope of practice, facility operations and billing requirements. In addition to all carotid stenting Standards listed, all applicant facilities and staff must comply with federal, state and local laws and regulations. The IAC Standards for Carotid Stenting Accreditation are the minimum Standards for facilities to acquire or maintain accreditation.
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