What is Carotid Artery Stenting?
Carotid angioplasty and stenting is a minimally invasive endovascular procedure that dilates the plaque blockage and widens the lumen of the artery. It is performed in an interventional Cath Lab.
When the carotid angioplasty and stenting procedure is performed the patient is awake. Carotid artery stenting is performed through catheter techniques, requiring only a small incision in the groin. A special catheter is inserted into the carotid artery with a windsock distal protection mesh between the blockage and the brain to protect clot from causing a stroke. This is called an embolic protection device. A tiny balloon is inflated once the catheter has been placed into the narrowed area. This dilates the artery and makes a larger opening for improved blood flow. A tiny, expandable metal coil called a stent is typically inserted into the newly-opened area to help keep the artery from narrowing or closing again. The stent remains in place permanently and functions as a framework or scaffolding to support the artery walls and keep the artery open. Several weeks after the surgery, the artery will heal around the stent.
Research has shown that carotid stenting, when used with an embolic protection device, was as safe and effective as carotid endarterectomy in high-risk symptomatic surgical patients.
Recovery from carotid angioplasty and stenting procedures usually requires a one-night hospital stay. Patients often return to normal activities within days after a procedure.
Angioplasty and stenting is typically indicated for select patients who:
- Have symptoms of TIA or stroke related to their carotid stenosis
- Have moderate to high-grade carotid stenosis > 70%.
- Have other medical conditions that increase the risk of surgical complications.
- Have recurrent stenosis.
- Have stenosis that was caused by prior radiation therapy.
Why is carotid artery stenting performed?
If you are at high-risk for surgery, your doctor may suggest carotid artery stenting. While this procedure is performed widely, the long-term effects are still being studied.
High-risk conditions under which carotid artery stenting may be considered include, but are not limited to:
- Older age
- Coronary artery disease or pending open heart surgery
- Heart failure, heart valve disease or heart arrhythmias
- Angina or heart attack within the last six months
- Contralateral occlusion of a carotid artery (closure of the other carotid artery already)
How to Prepare
Your doctor will explain the procedure to you and may ask any questions that you might have about the procedure.
You will need to fast prior to the procedure. Your doctor will notify you how long to fast, usually overnight.
Inform your doctor about:
- Any medications (prescription, over-the-counter or herbal supplements) you are taking.
- If you are pregnant or suspect that you may be pregnant.
- If you are allergic to or sensitive to medications, local anesthesia, or latex.
- If you have kidney failure or other kidney problems or if you are allergic to or sensitive to contrast dye or iodine.
Your doctor may request a blood test to determine how long it takes your blood to clot.
Follow-up care after the carotid artery stenting performed
After your procedure your doctor will want you to see him on a regular basis so that he can monitor your progress, typically by history, exam and Doppler vascular ultrasound.