What are the work restrictions after carotid artery stent (CAS) placement?

From the Guidelines

After carotid stent placement, patients should avoid strenuous physical activities and heavy lifting for about 1-2 weeks to minimize the risk of complications such as bleeding at the access site, stent displacement, or restenosis. The management of patients after carotid artery stent (CAS) placement is crucial for optimizing outcomes and preventing adverse events. According to the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1, proper pharmacological BP control is important in optimizing outcomes, and fluctuations of hypertension and hypotension should be treated promptly.

Key considerations for work restrictions after CAS placement include:

• Avoiding heavy lifting (over 10 pounds) for 1-2 weeks
• Avoiding strenuous physical activities for 1-2 weeks
• Returning to desk work within 3-7 days for most patients, but potentially 2-4 weeks for those with physically demanding jobs
• Avoiding driving for at least 24-48 hours after the procedure, or longer if taking narcotic pain medications
• Taking prescribed antiplatelet medications, such as aspirin and clopidogrel, to prevent stent thrombosis, with DAPT recommended for at least 30 days post-procedure 1

It is essential to note that the exact duration of restrictions may vary based on individual healing, comorbidities, and the physician's assessment of the procedure's success. Patients should gradually increase activity levels while monitoring for symptoms like dizziness, headache, or neurological changes. The intensive lipid-lowering therapy (ILT) aiming at >50% LDL-C reduction and LDL-C <1.4 mmol/L (55 mg/dL) is also recommended 1. By following these guidelines and recommendations, patients can minimize the risk of complications and optimize their outcomes after CAS placement.

From the Research

Work Restrictions after Carotid Artery Stent (CAS) Placement

There are no specific work restrictions mentioned in the provided studies. However, the following information can be gathered regarding the treatment and outcomes of CAS placement:

• Dual antiplatelet therapy (DAPT) is commonly used after CAS placement, with aspirin and clopidogrel being the most commonly used regimen 2.
• The optimal duration of DAPT after CAS placement is unclear, but studies suggest that short-duration DAPT (less than 6 months) may be as effective as long-duration DAPT in preventing ischemic stroke and other adverse events 3, 4.
• Platelet function monitoring may be used to guide antiplatelet therapy after CAS placement, and personalized treatment may improve outcomes 5.
• The risk of complications, such as stroke and death, is generally acceptable after CAS placement, and has improved with technological developments, including distal embolic protection 6.

Key Findings

• Dual antiplatelet therapy is commonly used after CAS placement, but the optimal duration is unclear.
• Short-duration DAPT may be as effective as long-duration DAPT in preventing ischemic stroke and other adverse events.
• Platelet function monitoring may be used to guide antiplatelet therapy after CAS placement.
• The risk of complications after CAS placement is generally acceptable and has improved with technological developments.

Treatment Considerations

• Dual antiplatelet therapy should be used after CAS placement, with aspirin and clopidogrel being the most commonly used regimen.
• The duration of DAPT should be individualized based on patient risk factors and response to treatment.
• Platelet function monitoring may be used to guide antiplatelet therapy after CAS placement.
• Patients should be closely monitored for complications, such as stroke and death, after CAS placement.