Carotid Artery Stenting

Carotid arteries are the two large blood vessels positioned on the sides of your neck that supply oxygenated blood to your brain, neck and face. The usual topic that arises under the discussion of Carotid arteries is the Carotid arteries disease which causes almost 10-20% of strokes

Is Carotid Artery A Serious Condition?

Similar to the blood vessels of the heart (coronary arteries) which get clogged by fat and cholesterol deposits (atherosclerosis), carotid arteries can also get blocked which could lead to a stroke or brain attack, which is regularly known as carotid disease. While one cannot experience any external symptoms of carotid disease, doctors can identify this condition by checking for a whooshing sound in the neck with stethoscope. The first sign of the disease will be TIA (a transient ischemic attack).

As a result of this disease, initially, the vessels start to narrow reducing the blood flow that eventually buildup plague causing blood clot blockage that ultimately led to fatal strokes. One of the ways through which doctors treat carotid artery disease is through Carotid Stenting.

What Is Carotid Stenting

Carotid stenting is a minimally invasive, non-surgical procedure wherein the clogged carotid arteries are opened by dilating them with a balloon (angioplasty) and inserting a metal scaffold to keep them open (stenting).

When Should I Opt For A Carotid Stenting Procedure?

Carotid stenting and angioplasty may be an appropriate stroke treatment or stroke prevention options if:

• You have a carotid artery with a 70 percent blockage or more, especially if you’ve had stroke or stroke symptoms.
• You had a narrowing of the carotid artery following radiation for neck tumours.
• You’ve already had a carotid endarterectomy and are experiencing new narrowing after surgery (restenosis).

How Exactly Does The Procedure Happen?

During this procedure, a specially designed guidewire with a filter is placed beyond the site of the narrowing or blockage in the carotid artery. Once the filter is in place, a small balloon catheter is guided to the area of the blockage. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened to increase blood flow. Then the balloon is removed and a tiny tube called a stent is placed inside the artery to widen the opening to support the artery wall.

After the stent is placed, an angiogram is performed to confirm that the stent has completely expanded and if the narrowing or blockage has been corrected. Often, a second balloon catheter is inflated to ensure the stent is maximally opened. The stent stays in place permanently and acts as a scaffold to support the artery and keep it open. After several weeks, the artery heals around the stent.

Usually, carotid stents are used along with a device called the embolic protection device (EPD). The EPD looks like an umbrella or windsock and contains a basket to catch plaque particles dislodged during the stenting procedure. By catching these particles, it prevents them from travelling in the blood to the brain and reduces the risk of a blood clot or stroke.

What Should I Expect After Completion Of The Procedure?

After the access sheath is removed, you will be required to lay flat without bending your legs to prevent bleeding. Then you may receive medication to reduce discomfort. Your doctor will determine how long you will have to lay flat, which could be from two to six hours.

Plan on staying overnight in the hospital after the procedure. You will be evaluated by your doctor. Then they will conduct a neurological exam and other tests, such as a carotid ultrasound, to evaluate the results and will discuss the results of the procedure with you and your family.

Before you go home, you will be given instructions about your medications, balanced diet, activity, and follow-ups.

Your doctor will prescribe aspirin and clopilet to take for six months after the procedure. These medications will help to prevent blood clots from forming at the site where the stent was placed. Follow your doctor’s instructions about medication timings. Do not stop taking these medications without consulting your doctor.

After the procedure, you will need to take it easy for a few days. You can climb stairs but use a slower pace. Do not strain during bowel movements. By the end of the week, gradually increase your activities until you reach your normal activity level.

What Are The Risks I Should Be Aware Of Before Undergoing Carotid Stenting?

As with any surgical procedure, complications may occur. The following are some of the complications that may be associated with carotid angioplasty and stenting:

• Stroke or ministroke (transient ischemic attack, or TIA): During angioplasty, blood clots that may form on the catheters can break loose and travel to your brain. But blood thinners are given during the procedure to reduce this risk.

A stroke can also occur if plaques in your artery are dislodged when the catheters are being threaded through the blood vessels.

• Blood clots: Blood clots may form within stents weeks or months after the procedure… These clots may cause a stroke. It’s important to take aspirin, clopidogrel and other medications exactly as prescribed to decrease the chance of clots forming in your stent.
• Bleeding: You may have bleeding at the site in your leg where catheters were inserted. Usually, this simply results in a bruise, but rarely serious bleeding occurs and may require a blood transfusion or surgical procedures.

Can Carotid Stenting Procedure Completely Cure Carotid Disease?

For most people, the carotid angioplasty and stenting procedure increases blood flow to the brain and decreases the risk of a stroke. Although the carotid stenting procedure opens up a blocked carotid artery, it does not cure carotid artery disease. You will still need to focus on reducing your risk factors by making certain lifestyle changes to prevent future disease development or progression.

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Also Read: Heart Healthy Diet

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So, to achieve the best results, you must be committed to living a healthy lifestyle that includes quitting smoking, taking medications as prescribed, taking and recording your blood pressure, following a heart-healthy diet, managing high blood pressure, cholesterol and diabetes and continuous follow-ups as recommended by your doctor.