Home Instructions after Carotid Stenting

Going home

A responsible adult MUST drive you home. You will not be able to leave the hospital unless there is someone available to drive you home.

If you have more than a two-hour drive home, we suggest that you stay overnight in a hotel for your comfort. Then have your family member drive you home the next morning, after you have rested.

During your drive home, stop every hour and walk for 5 to 10 minutes. If you are traveling home by plane, stand up to stretch your legs and walk in the aisle at least one time every hour.

Please ask your doctor when you can drive again.

Caring for the catheter insertion site

• When you go home, there will be a bandage (dressing) over the catheter insertion site (also called the wound site). You may take the dressing off the next morning.
• It is easiest to remove the dressing in the shower ” get the tape and dressing wet and remove it. It is okay to get the wound site wet. Pat the area dry after you shower.
• After you remove the bandage and dry the site, cover the area with a small adhesive bandage (ie. Band-Aid). It is normal for the site to be bruised for a couple of days. The site may also be a little swollen and pink, and there may be a small lump (about the size of a 50 UAE fils) at the site. You may also have some drainage from the site for a few days.
• Wash the catheter insertion site with soap and water at least once a day. It is okay to do this in the shower. Place soapy water on your hand or washcloth and gently wash the insertion site; do not rub. Do not take a bath.
• Keep the area clean, dry and covered with a bandage when you are not showering.
• Do not use creams, lotions or ointment on the wound site
• Do not take a bath, soak in the tub, go in a Jacuzzi, or swim for one week after the procedure
• If you have stitches, you will get instructions on how to care for the incision. Stitches are usually removed a week after the procedure.

When to call 999

Call 999 (or 911 if you are in the US) or go to your local emergency department right away if you have:

• Sudden numbness or weakness in your face, arm or leg, especially if it only affects one side of your body.
• Sudden trouble understanding or speaking, including slurred speech or confused speech.
• Sudden trouble seeing (one or both eyes).
• Sudden loss of balance, coordination, or ability to walk.
• Fainting spells.
• Sudden, severe headache without a known cause.
• Bleeding from the catheter insertion site.
• Bleeding is rare, but if it happens, remove all of the dressing over the site. Use a clean compress (clean gauze, wash cloth) to put pressure directly on the site. Call 999 if the bleeding does not stop after 20 minutes. Emergency workers will take over your care when they arrive.
• Fast heart rate - more than 150 beats per minute.
• New irregular heart beat.
• Shortness of breath that does NOT stop when you rest.

Blood pressure

Your doctor may ask you to keep track of your blood pressure after the procedure (for example, twice a day for 2 weeks). If your blood pressure is high (more than 150/90) on a regular basis, call your doctor's office to let them know.

Activity guidelines

Your doctor will tell you when you can go back to your regular activities. In general, you will need to take it easy for the first two days after you get home. Expect to feel tired and weak the day after the procedure. Take walks around your house and plan to rest during the day.

• Do not lift anything that weighs more than 4.5 kilograms for 5 to 7 days after the procedure
• Do not push or pull heavy objects for 5 to 7 days after the procedure
• Do not do anything strenuous for 5 days after the procedure. This includes most sports, including jogging, golfing, playing tennis and bowling.
• You may walk up and down stairs if you need to, but walk more slowly than usual
• Slowly do more activities during the week after the procedure until you are back to your regular routine
• Ask your doctor how long you should wait until you resume sexual activity

Driving

Ask your doctor when you can drive again. Most times, it is safe to drive within 24 hours after you go home.

When to call your doctor

Call your Cleveland Clinic or local doctor if you have:

• Pus-like drainage, redness or unusual warmth at the catheter insertion site.
• Temperature over 38.3 °C.
• Coldness, numbness, tingling or a lot of swelling in the leg or arm on the side of your body used to insert the catheter.
• A golf-ball sized lump aatthe insertion site.
• Extreme pain or swelling at the catheter insertion site.
• Chest discomfort, excessive shortness of breath, dizziness or irregular heartbeats that last 20 minutes or longer when you are active or hhappenon a regular basis.
• Questions about your procedures, medications, follow-up schedule or treatment plan.
• Persistent high bloos pressure after the procedure.

Returning to work

Most people are able to return to work within 1 to 2 weeks after the procedure. Ask your doctor for specific guidelines for your return to your job.

Medications

• Please review your medications with your doctor before you go home. Ask your doctor if you should continue taking the medications you were taking before the procedure.
• If you have diabetes, your doctor may adjust your diabetes medications for 1 to 2 days after your procedure. You may need to stop taking Glucophage (metformin hydrochloride) or Glucovance for 48 hours after the procedure to reduce the risk of kidney problems. Ask your doctor for exact directions about taking your diabetes medication after the procedure.
• You may take Panadol to relieve pain at the procedure site.
• You will take antiplatelet medication and aspirin to prevent blood clots from forming after the procedure (unless you there is a medical reason why you cannot take these medications). Your doctor will let you know which medications to take and how to take them.
• You may also need to take medication to lower your cholesterol or a heart medication (beta blocker, calcium channel blocker) to keep your arteries open.
• It is VERY IMPORTANT to take these medications as prescribed until your doctor tells you to stop taking them.
• Depending on the results of your procedure, you may have changes to your regular medication routine (new medications, changes in dosage, etc).
• Please make sure you understand what medications you should be taking after the procedure and how often to take them. Ask your doctor, nurse or pharmacist if you have ANY questions about your medication.
• You can fill your prescriptions at a Cleveland Clinic pharmacy before you go home. If you need help filling or paying for your medications, please let us know.

Fluid guidelines

Drink 8 to 10 glasses of clear fluids (water is best) to flush the contrast material from your system after your procedure.

Restenosis

Restenosis is a blockage in the treated artery that happens within the first 6 months after your procedure. It is caused by a build-up of scar tissue at the treatment site. The risk of restenosis depends on the type of treatment you had and the result.

If you have symptoms like the ones you had before your procedure, it is possible that you have restenosis or a new blockage. Call your doctor as soon as you notice symptoms. If symptoms last longer than 5 minutes, call 911.

Importance of heart-healthy lifestyle

Interventional procedures open blocked arteries, but they do not CURE carotid artery disease. You still need to reduce your risk factors and make changes to prevent new problems and keep the disease from getting worse.

The best results come with a commitment to a heart-healthy lifestyle. Your healthcare team can help you reach your goals, but it is up to you to take your medications as prescribed, make changes in your diet, quit smoking, exercise regularly, keep your follow-up appointments and be an active member of the treatment team.

If you aren't sure about the changes you need to make, as your doctor or nurse.

Cardiac rehabilitation

A cardiac rehabilitation program that includes education and supervised activity may help you make healthy lifestyle changes. Ask your doctor for more information about programs in your community.

Follow Up

We will contact your referring or primary care doctor by phone or fax to discuss the results of your procedure. Please call your primary care doctor as soon as you return home to find out when you need to be seen.

Your doctor will receive a written report from Cleveland Clinic by mail. It includes a general summary of your medical condition, including the procedure you had done, the medications you were prescribed and your care plan.