Monitoring During the Procedure

It goes without saying that an anesthesiologist should be present for the procedure with neu-roleptic analgesia and to monitor the patient. Heparin is given after femoral access. Atropine is given prior to dilatation. There is monitoring of ECG and blood pressure, as well as transcra-nial Doppler monitoring of the middle cerebral artery velocity. Heparin is given 24 hours post-procedure. Aspirin is given pre-procedure and for life. There may also be a role for the new anti-platelet agents, such as Clopidogrel.

Both self-expanding and balloon-expanding stents have advantages and the ideal stent is yet to be designed. My personal preference is to use a self-expandable stent. Use of cerebral protection has strongly been advocated and Theron reports excellent results [34]. The main complication of angioplasty and stenting is ipsilateral stroke, thought to be mainly due to emboliza-tion of plaque material during the procedure. A balloon occlusion device (Percusurge) and a filter are commercially available and are increasingly used during these procedures.

With respect to PTA or stenting, there are several rationales for primary stenting. Primary stenting has the advantage that the adverse consequences of any dissection or plaque rupture initiated by balloon angioplasty are minimized because the stent maintains a laminar flow across the stenosis and seals the site of dissection, preventing a free intimal flap. In addition, the mesh size may limit the size of any thrombus or debris which may be dislodged.

With respect to re-stenoses, there is little long-term data available for stents. However, a re-stenosis rate of 6% has been shown with a Strecker stent, and our own experience and that of the CAVATAS operators is that, although there is a better immediate result after stenting at 1 month, the re-stenosis rate at 1 and 2 years is similar in the stent and no-stent groups. Re-stenosis is also unlikely to have any correlation with symptoms (Clifton AG (1999) Re-stenosis after carotid angio-plasty, stenting and endarterectomy, and its relations to symptomatology. Personal communication/presentation to the Working Group on Interventional Neuroradiology, Val d'Isere, on behalf of the CAVATAS collaborators).

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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