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Aneurysm III: Interprofessional Care

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Nursing management for a patient with arteriosclerosis involves a comprehensive approach focusing on lifestyle modification, disease monitoring, education, and symptomatic care. Here is an overview of effective nursing strategies:Assessment and Monitoring: Initial and ongoing assessments are crucial. Nurses must document the patient's medical history, including any hypertension, diabetes, hyperlipidemia, and other cardiovascular diseases. Assessments also cover family history and lifestyle...
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Coronary Artery Disease V: Interprofessional Care01:27

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Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Implantation of a Carotid Cuff for Triggering Shear-stress Induced Atherosclerosis in Mice
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Symptomatic carotid webs require aggressive intervention.

Clayton J Brinster1, James O'Leary1, Aaron Hayson1

  • 1Vascular Surgery Section, Ochsner Health, New Orleans, LA.

Journal of Vascular Surgery
|September 8, 2023
PubMed
Summary
This summary is machine-generated.

Symptomatic Carotid web (CaWeb) is a rare cause of embolic stroke, often misdiagnosed. Aggressive intervention, not medical management, is crucial for preventing recurrent strokes in CaWeb patients.

Keywords:
Carotid endarterectomyCarotid webCryptogenic strokeEmbolic stroke of unknown sourceFMDFibromuscular dysplasia

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Area of Science:

  • Vascular Neurology
  • Interventional Neuroradiology
  • Cerebrovascular Disease

Background:

  • Carotid web (CaWeb) is a rare fibromuscular dysplasia variant linked to embolic stroke.
  • Misdiagnosis as cryptogenic stroke is common, leading to potentially devastating recurrent events.
  • Limited literature exists on CaWeb natural history and optimal management strategies.

Purpose of the Study:

  • To analyze the largest single-institution cohort of symptomatic CaWeb patients.
  • To evaluate diagnostic accuracy of imaging modalities.
  • To compare outcomes of medical versus interventional management.

Main Methods:

  • Defined CaWeb as a linear projection in the carotid bulb causing a filling defect on CTA/angiography.
  • Identified 52 symptomatic CaWeb cases over 6 years (2016-2022).
  • Reviewed initial presentation, diagnostic imaging, and management outcomes (medical vs. surgical/stenting).

Main Results:

  • 67% of patients were African American; 35% were African American women under 50.
  • 90% presented with stroke; stenosis was <50% in 94%.
  • Medical management led to recurrent stroke in 19% (all cases), while intervention showed no post-procedure stroke over 38 months follow-up.

Conclusions:

  • Carotid duplex is inadequate for CaWeb diagnosis; CTA/angiography is essential.
  • Medical management is unacceptable for symptomatic CaWeb due to high recurrence rates.
  • An aggressive interventional approach for symptomatic CaWeb significantly reduces recurrent stroke risk.