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Carotid Stent Fractures Are Not Associated With Adverse Events: Results From the ACT-1 Multicenter Randomized Trial (Carotid Angioplasty and Stenting Versus Endarterectomy in Asymptomatic Subjects Who Are at Standard Risk for Carotid Endarterectomy With Significant Extracranial Carotid Stenotic Disease). Circulation 2018; 137:49. https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 33/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate Topic 1104 Version 36.0 https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 34/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate GRAPHICS Angiographic criteria for internal carotid near-occlusion The figures illustrate the four criteria for internal carotid near-occlusion on conventional angiography. In all figures, the intravenous contrast (gray color) is shown emanating from a catheter positioned in the CCA. (A) Delayed filling (B) Evidence of intracranial collaterals when the contralateral side is examined (C) Ipsilateral distal ICA diameter less than the contralateral distal ICA diameter (D) Ipsilateral distal ICA diameter equal to or less than the ipsilateral ECA diameter CCA: common carotid artery; ICA: internal carotid artery; ECA: external carotid artery. Modi ed with permission of the American Society of Neuroradiology, from: Johansson E, Fox AJ. Carotid Near- Occlusion: A Comprehensive Review, Part 1 De nition, Terminology, and Diagnosis. AJNR Am J Neuroradiol 2016; https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 35/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate 37:2; permission conveyed through Copyright Clearance Center, Inc. Copyright 2016. Graphic 129242 Version 1.0 https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 36/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate Antimicrobial prophylaxis for percutaneous procedures in adults Potential Routine First- Common Procedure organisms prophylaxis choice Comment antibiotic choices encountered recommended antibiotic Angiography, Staphylococcus No None Cefazolin (2 g IV if Procedure angioplasty, aureus, S. <120 kg, 3 g IV if 120 kg IV) (if high- risk stent infection). If penicillin-allergic, can classificatio thrombolysis, arterial closure epidermidis clean device use vancomycin (15 placement, stent mg/kg IV; max 2 g) or clindamycin (900 mg placement IV). Endograft placement S. aureus, S. epidermidis Yes Cefazolin (2 g IV if <120 kg, 3 g IV if 120 kg IV) If penicillin-allergic, can use vancomycin or clindamycin Procedure classificatio clean Superficial venous S. aureus, S. epidermidis No None None Procedure classificatio insufficiency treatment clean IVC filter placement S. aureus, S. epidermidis No None None Procedure classificatio clean Tunneled central venous S. aureus, S. epidermidis No consensus None Cefazolin (2 g IV if <120 kg, 3 g IV if 120 kg IV) (eg, immunocompromised patients before chemotherapy; Procedure classificatio clean access (nontunnele catheter: no prophylaxis history of catheter infection). If penicillin- allergic, can use vancomycin (15 mg/kg IV; max 2 g) or clindamycin (900 mg IV). IV: intravenous; IVC: inferior vena cava. https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 37/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate Reproduced from: Venkatesan AM, Kundu S, Sacks D, et al. Practice guideline for adult antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol 2010; 21:1611. Table used with the permission of Elsevier Inc. All rights reserved. Graphic 63103 Version 9.0 https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 38/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate Periprocedural DAPT for transfemoral carotid artery stenting* Refer to UpToDate topics on carotid artery stenting for additional details of our approach to treatment and the overall efficacy of these treatments. DAPT: dual antiplatelet therapy; ASA: aspirin; TF-CAS: transfemoral carotid artery stenting. We use a regimen based on the Carotid Revascularization Endarterectomy versus Stent (CREST) Trial. We also provide statin therapy. For those not already on statins, we initiate atorvastatin 40 mg orally once daily for seven days before the procedure or we give a loading dose of 80 mg orally once 12 hours before the procedure. The timing of the DAPT loading and subsequent dosing depends on procedure scheduling. Typically, we provide loading doses once the procedure is scheduled and provide daily dosing starting 12 hours after the loading doses up until the time of the procedure. For urgent cases, loading doses are provided no less than four hours before the procedure. For TF-CAS, although we favor higher doses, guidelines support a range of 75 to 325 mg ASA. https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 39/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate For patients with a history of neck irradiation, we continue DAPT indefinitely. Graphic 131243 Version 2.0 https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 40/41 7/5/23, 11:42 AM Overview of carotid artery stenting - UpToDate Contributor Disclosures Jeffrey Jim, MD, MPHS, FACS Consultant/Advisory Boards: Endospan [Aortic interventions]; Medtronic [Aortic interventions]; Silk Road Medical [Carotid stent]. All of the relevant financial relationships listed have been mitigated. John F Eidt, MD Grant/Research/Clinical Trial Support: Syntactx [Clinical events, data/safety monitoring for medical device trials]. All of the relevant financial relationships listed have been mitigated. Joseph L Mills, Sr, MD No relevant financial relationship(s) with ineligible companies to disclose. Kathryn A Collins, MD, PhD, FACS No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/overview-of-carotid-artery-stenting/print 41/41