viagra vs viagra bodybuilding Cks or cerebral infarction, and also selected patients who have severe narrowing of the carotid artery without symptoms, according to dr. buy viagra in us cheap viagra online cheap viagra viagra for sale viagra for sale buy generic viagra cheap viagra online buy viagra cheap generic viagra cheap generic viagra Brown and neurosurgeon giuseppe lanzino, m. D. Most patients arrive at the cerebrovascular clinic at mayo clinic in rochester, minnesota, after carotid ultrasonography, magnetic resonance angiography, or computed tomographic angiography has shown narrowing of the carotid artery. After thoroughly examining the patient, the multidisciplinary neuroscience team members decide whether cas placement is the appropriate treatment. If it is, the patient proceeds to the interventional neuroradiology suite in saint marys hospital for further evaluation. The patient is sedated but awake. A small plastic catheter is inserted in a groin artery and tracked through the aorta to the carotid arteries. Next, contrast material is injected to delineate the anatomy. If the angiogram confirms severe narrowing that could be best treated with cas placement, the procedure begins. First, a protection device may be deployed distally in the carotid artery. This device functions something like a tiny mesh umbrella to catch material that may break free during the angioplasty. Then the angioplasty balloon is advanced across the plaque and inflated to push the plaque aside, thus reducing arterial narrowing. The stent — a small metallic scaffolding device — is put in place to keep the artery open. The procedure ends with withdrawal of the distal protection device and the catheter. Typically, the patient is hospitalized for one day. Aftercare involves taking clopidogrel and aspirin daily for one month to prevent blood clots from forming at the stent site and then aspirin alone indefinitely thereafter. Mayo clinic specialists follow each patient long term, both to assess durability of the stent and to determine whether narrowing recurs. Follow-up includes annual carotid ultrasonography that begins several months after the procedure. Preoperative image of narrowed carotid artery enlarge postoperative angiogram showing stent in place enlarge results, risks, and complications the concept of cas placement is a logical extension of the balloon stenting used for coronary artery disease. Initially, in the early 1990s, cas placement was performed on patients who were at high risk for conventional surgery.   the outcomes of these early cases were excellent, and the risk of stroke and death was extremely low. Because these measures of success were so similar to those of the standard treatment, carotid endarterectomy, the use of cas placement was cautiously and carefully expanded. Since then, mayo clinic experience with cas placement sug.