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3. Adjunctive Pharmacology

Placing the stent delivery catheter in a safe and expeditious fashion is the key to successful carotid stenting . . 4. Sheath placement.. . Responses may include.. Exchange 0.038 glide for extra stiff glide or 0.035 - 0.038 exchange wireRemove 5F catheter over the stiff exchange wire and reintroduce original dilator; then advance sheath7F sheath instead of 6FTERMINATE PROCEDURE!!.

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3. Adjunctive Pharmacology

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    1. 3. Adjunctive Pharmacology Dual Antiplatelet Rx ASA - 325 mg bid. Plavix (clopidegrel) - 75 mg bid. Pre treat all patients with Atropine Heparin, Angiomax (Bivalirudin) Neo-synephrin (100ug/cc), Dopamine, NGL No IIB/IIIA agents

    2. Placing the stent delivery catheter in a safe and expeditious fashion is the key to successful carotid stenting .

    3. Responses may include. Exchange 0.038 glide for extra stiff glide or 0.035 - 0.038 exchange wire Remove 5F catheter over the stiff exchange wire and reintroduce original dilator; then advance sheath 7F sheath instead of 6F TERMINATE PROCEDURE!!

    4. Use Sheaths not Guides Guiding catheters were designed to access the origin of vessels not be rammed into them. Sheaths with introducers are designed to atraumatically access vessels. For calcified more complex angulated lesions where more support is needed use a 7F. Sheath and if necessary you have the real-estate to support the sheath with a buddy-wire placed into the external carotid.

    5. Remember! Reassess the patient selection process after the sheath is in place ! Decision to proceed is made after sheath placemen!

    7. Cant place EPD with ample landing zone for stent ! stop procedure!

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