Carotid angioplasty and stenting
Carotid angioplasty is often combined with placing small metal coils called stents into the blocked artery. Stents supports the artery's openning and reduce the chance of re-narrowing.
Carotid angioplasty and stenting is a procedure that opens blocked arteries to prevent or treat stroke. The carotid arteries are located on each side of the neck and are the main arteries that supply blood to the brain. The procedure involves temporarily inserting and straining a small balloon where the carotid artery is blocked to widen the artery.
Carotid angioplasty is often combined with placing small metal coils called stents into the blocked artery. Stents support the artery's opening and reduce the chance of re-narrowing. Carotid angioplasty and stenting may be used when traditional carotid surgery is not feasible or too risky.
Reason for doing this
If you already have severe carotid stenosis (atherosclerosis), even without symptoms of a stroke, you may be a candidate for carotid angioplasty and stenting. In some cases, traditional carotid surgery may be advised to remove the plaque (fat) that is the narrowing of the artery. In other cases, angioplasty and stenting may be a better option.
Carotid angioplasty and stenting may be an appropriate stroke treatment or stroke prevention option in case:
Have had a stroke or transient ischemic attack.
The carotid artery is 70 percent or more blocked, especially if you've had symptoms of a stroke.
Are not healthy enough to undergo surgery, for example, if you have heart disease, severe lung disease, have radiation for neck tumors, or if you have had a carotid ablation and new narrowing after surgery.
The location of the narrowing is difficult to access with intra-arterial ablation.
As with any surgical procedure, complications can occur. The following complications are possible with carotid angioplasty and stenting:
Stroke or transient ischemic attack. During angioplasty, the blood clot can break up and travel to the brain. Blood thinners are given during the procedure to reduce this risk. A stroke can also occur if the plaque in an artery moves as the catheter is threaded through a blood vessel.
Re-narrowing of the carotid artery. A major downside of carotid angioplasty is the chance that the artery will narrow in the months following the procedure. Stents were developed to reduce the risk of restenosis.
Blood clot. Blood clots can form within stents, even weeks or months after angioplasty. These blood clots can cause a stroke or death. It is important to take aspirin, clopidogrel, and other medications exactly as prescribed to reduce the risk of blood clots forming in the stent.
Bleeding. There may be bleeding in the leg where the catheter was inserted. Usually simply a bruise, but sometimes severe bleeding occurs and may require blood transfusions or surgical procedures.
Before recommending an angioplasty, the doctor reviews the medical history and performs a physical exam. You may also undergo one or more visits before the angioplasty and stenting procedure:
Supersonic. The scanner passes through the carotid artery to create images (using sound waves) of the narrowed artery and of the blood flow to the brain.
Magnetic resonance imaging (MRA) or tomography (CTA). These tests provide detailed images of blood vessels using radiofrequency waves either in a magnetic field or by using X-rays.
Carotid angiography. In this test, contrast material (visible on an X-ray) is injected into an artery so it can be seen and examined.
Get instructions on what you can or cannot eat or drink before angioplasty. Preparation may be different if you were in the hospital before the procedure.
The night before the procedure. Follow your doctor's instructions about adjusting your current medication. Your doctor may instruct you to stop taking certain medications before angioplasty, especially if you take diabetes medications or blood thinners.
Take the prescribed medication with only small sips of water.
Carotid angioplasty usually requires an overnight hospital stay, and it is not possible to drive home alone the next day because of the lingering effects of the sedatives.
What can be expected
Carotid angioplasty is considered a medical procedure because it is less invasive than surgery. The body is not cut open except for a very small cut in a blood vessel in the groin.
General anesthesia is not required, so stay awake during the procedure. You will receive fluids and medicine to relax you through an intravenous (IV) catheter.
Before the tricks. You will be directed to an X-ray room and asked to lie on a procedure bed. The groin area is prepared with sterilization.
A local anesthetic is injected into the groin to numb the area.
Small electrode pads are placed on the chest to monitor heart rate during the procedure.
In the trick. While sedated, the doctor makes a hole in an artery, usually the femoral artery in the groin area.
The following steps describe angioplasty and stenting
A small tube is placed into the artery. The catheter is then threaded through the tube to the narrowing in the carotid artery according to radiographic guidance. The catheter will not be felt through the arteries because the inside of the artery has no nerves.
Contrasting material is injected into the carotid artery through a catheter. Contrasting material may cause a temporary warm sensation on one side of the face. In contrast, the material provides a detailed view of the narrowed artery and blood flow to the brain.
A filter is set. The filter is inserted over the narrowing to catch any debris that may break from the narrowing area during the procedure.
The balloon is inserted into the narrowed area and inflated to forcefully push the plaque to the side and widen the lumen.
A small metal mesh tube (stent) may be placed in the vein that has just been opened. Expanded stents help prevent the artery from slowly narrowing.
Filter, housing, and catheter are removed. Pressure is applied to the catheter site to prevent bleeding.
When the procedure is done, remain lying down while pressure is applied to the catheter site to stop bleeding. You will then be taken to the recovery area.
After the tricks
To avoid bleeding from the catheter insertion sites, several hours are still required, either in the recovery area or in the hospital room. After the procedure, you may get a carotid ultrasound. Most people are discharged from the hospital the day after the procedure.
The catheter insertion site is swollen and bruised for a few days. There may be a small area of discoloration or mild pain. The recommended dose of acetaminophen for discomfort may be used, or other medication prescribed by your doctor.
It may be necessary to avoid strenuous activity and lifting anything over 4.5 kg for 24 hours after the procedure.
For most people, carotid artery dilation and stenting increase blood flow through previously blocked arteries and reduces the risk or symptoms of a stroke. However, if symptoms return, such as problems walking or speaking, numbness on one side of the body, or other symptoms similar to those experienced before the procedure, contact your doctor.
Carotid angioplasty and stenting are not appropriate for everyone. Your doctor can determine if the benefits outweigh the potential risks. Because carotid angioplasty is a newer, more traditional procedure, the long-term outcomes are still under investigation. Talk to your doctor about what results to expect and what kind of follow-up is needed after the procedure.
Lifestyle changes that will help maintain good results include:
Lower cholesterol levels.
Maintain a healthy weight.
Control other problems, like diabetes, high blood pressure, and sleep apnea.