Overview
What Is Carotid Artery Stenting ?
Carotid artery stenting is a procedure in which your vascular surgeon inserts a slender, metal-mesh tube, called a stent, which expands inside your carotid artery to increase blood flow in areas blocked by plaque.
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. Eventually, enough plaque may build up to reduce blood flow through your arteries, or cause blood clots or pieces of plaque to break free and to block the arteries in the brain beyond the plaque.
What Can I Expect After Carotid Stenting ?
Immediately after the procedure, your physician applies pressure to the catheter insertion site in the groin or arm for 15 to 30 minutes to allow it to close and prevent bleeding. Sometimes to close the incision, your physician may use, instead, a cork-like closure device or stitches that dissolve.
If your physician inserts the catheters and other instruments through your femoral artery, your physician may instruct you to stay in bed for the next several hours so that he or she can watch for any complications, such as bleeding from the puncture site.
Your physician may instruct you not to lift anything more than about 5 to 10 pounds after you return home, to avoid any pressure on the incision. Your physician may also instruct you not to take a bath for a few days (but showers are usually fine), and to drink plenty of water to help flush the dye out of your system. You will be advised to take blood thinning medications and also be scheduled for periodic follow-up examinations, usually including carotid ultrasound examinations, to monitor the function of your stent over time.
How Do I Prepare ?
Your physician may give you specific instructions to follow before the procedure, such as fasting. You should always inform your physician about any medications that you are taking.
In most cases, your physician will instruct you take aspirin and a prescription medication that prevents clots for 3 to 5 days before the procedure. Your physician 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.
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
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 restenosis, 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.
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