What is carotid artery stenting?
Carotid artery stenting is a procedure in which we insert a slender, metal-mesh tube, called a stent, which expands inside your carotid artery to increase blood flow in areas blocked by plaque. We may recommend that you have a stent inserted as an alternative to surgical removal of the plaque, known as carotid endarterectomy.
Hardening of the arteries, also known as atherosclerosis, can cause a build-up of plaque. In hardening of the arteries, plaque builds up in the walls of your arteries as you age. Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque accumulates, your arteries can narrow and stiffen. Plaque may build up to reduce blood flow through your arteries or cause blood clots or pieces of plaque to break free.
Your carotid arteries are located on each side of your neck; these arteries supply blood to your brain. You have one main carotid artery on each side, and the internal carotid artery supplies blood to the brain. If a clot or plaque blocks the blood flow to your brain, it can cause an ischemic stroke, which can cause brain damage or death. An ischemic stroke is a stroke that occurs because there is a lack of blood flow to cells in the brain. Another related problem that the plaque can cause is an arterial embolism. This occurs when a small piece of plaque or a blood clot breaks away from the site where it formed and blocks another artery downstream. If a clot blocks a tiny artery in the brain, it may cause temporary neurological symptoms, called transient ischemic attacks (TIAs), sometimes called “mini-strokes.”
How do I prepare?
We will give you specific instructions to follow before the procedure, such as fasting. You should always inform us about any medications that you are taking.
In most cases, we will instruct you take aspirin and a prescription medication that prevents clots for 3 to 5 days before the procedure. We may also order a duplex ultrasound, a computed tomography (CT) scan, an angiogram, or magnetic resonance imaging (MRI) to evaluate the degree of blockage in your carotid artery.
Am I a candidate for carotid stenting?
At the present time, carotid stenting has been approved for the treatment of patients with symptomatic carotid artery disease who are considered to be too high risk for carotid endarterectomy. You may be a candidate for the procedure if you are considered high risk for carotid endarterectomy, if your carotid artery is significantly narrowed (usually by more than 70 percent), and if you have had symptoms of a mini-stroke or stroke. If you fall outside of these categories, you may be a candidate for enrollment in a clinical trial evaluating the outcomes of carotid artery stent placement.
You may not be a candidate if you have one or more of the following:
- A life expectancy shorter than 2 years
- An irregular heart rhythm
- An allergy to any of the medications used in the procedure
- Bleeding in your brain within the last 2 months
- Complete obstruction of the carotid artery
Am I at risk for complications during carotid stenting?
Factors that may increase your chance for having complications during carotid stenting include:
- High blood pressure
- An allergy to contrast dye
- Hardened (calcified) and long narrowing of the carotid artery
- Sharp bends or other difficult anatomies in the carotid arteries
- Irregular-looking plaque
- Significant plaque or atherosclerosis of the aorta near the beginning of the carotid artery
- An age more than 80 years
- Extensive blockages in the arm and leg arteries
- Poor kidney function
How is carotid stenting performed?
The procedure usually takes place in an angiography suite. Before the procedure begins, we will connect you to a monitor that shows your heart rate and blood pressure. During the procedure, your physician will likely talk with you and may instruct you to squeeze a small toy or ball so that he or she can monitor your brain function.
We will insert a small balloon, basket, or filter called an embolic protection device. This device helps to prevent strokes by catching the clots or debris that may break away from the plaque during the procedure.
At the blockage site, we inflate a balloon to flatten the plaque and widen the space where the blood flows through. We then guide a metal stent to the same area in your carotid artery. The stent then expands to fit the artery. Stents remain permanently in your carotid artery. Because stents are made of stainless steel or metal alloys, they resist rust.
Carotid stenting usually takes about 1-2 hours but may take longer in some circumstances.
What can I expect after carotid stenting?
Immediately after the procedure, we appliy pressure to the catheter insertion site in the groin or arm for 15 to 30 minutes to allow it to close and prevent bleeding. You will be asked to stay in bed for several hours so that we can watch for any complications, such as bleeding from the puncture site. We will give you detailed instructions at the time of the procedure.
Are there any complications?
Blockage by a clot or other debris in an artery in your brain, called an embolism, is the most serious complication that can occur after carotid stenting. This blockage can cause a stroke. Other complications that may cause a stroke include a blood clot forming along the stent or a tear in the artery wall called a dissection. The re-blockage of the carotid artery, called re-stenosis, is another possible complication. The dye used for the angiogram can sometimes cause damage to the kidneys, especially in people who already have kidney trouble. Bleeding from the puncture site in the groin or arm artery, called a hematoma or a false aneurysm, can also occur, but this is unusual. Bruising and mild tenderness at the puncture site is common, however, and usually resolves with time.
What can I do to stay healthy?
Although carotid stenting opens your artery and keeps blood flowing, it does not stop plaque from building up. To prevent hardening of the arteries from occurring again, you should consider the following changes:
- Eat more foods low in saturated fat, cholesterol, and calories
- Exercise regularly, especially aerobic exercises such as walking
- Maintain your ideal body weight
- Quit smoking
- Follow your physician’s recommendations for medications to control cholesterol and to thin the blood