What is Carotid Stenting?
Carotid stenting or carotid angioplasty and stenting is a minimally invasive medical procedure to treat narrowed or blocked carotid arteries, the arteries in the neck that supply blood to the head.
The procedure involves inserting a catheter into the groin and advancing it to the carotid arteries in the neck. By inflating a small balloon inside the artery and then placing a metal mesh stent, the narrowed or blocked artery is opened thereby increasing blood flow to the brain.
Carotid stenting may be performed on an emergency basis following a stroke or on an elective basis when conservative treatment measures have failed to relieve symptoms of carotid artery disease.
Indications for Carotid Stenting
Carotid angioplasty and stenting is indicated as an alternative to open surgery (carotid endarterectomy) for the treatment of carotid artery disease.
Carotid artery disease, also referred to as carotid artery stenosis or carotid occlusive disease, occurs due to the deposition of plaque (fatty substances) inside the walls of your carotid (neck) arteries. These arteries supply oxygen-rich blood from the heart to your brain. Due to plaque accumulation, the arteries become narrower or even completely blocked. This reduces blood flow to your brain and creates oxygen deficiency, increasing your risk of having a stroke.
Carotid angioplasty and stenting may be an appropriate option for patients with:
- Asymptomatic (without symptoms) carotid artery disease with blockage of 80% or more
- Symptomatic (with symptoms) carotid artery disease with blockage of 50 % or more
- New narrowing or blockage, after carotid endarterectomy or angioplasty
- Severe heart or lung diseases
- Previous neck surgery
- History of radiation therapy for neck tumours
- Narrowing or blockage that is hard to approach with endarterectomy
Preparation for Carotid Stenting
Prior to the procedure, your doctor will evaluate your medical history and perform a detailed physical examination. Additional tests may be ordered to detect the presence of blood clots, blockages, or narrowed carotid arteries. These include:
- Ultrasound of the carotid artery using high-frequency sound waves to measure the flow of blood through your blood vessels.
- Imaging tests such as computerised tomography (CT) or magnetic resonance imaging (MRI) scans.
- Carotid angiogram: In this procedure, a contrast dye is injected into your carotid arteries and with the help of a live X-ray, images of your neck and brain are collected. This helps to understand the flow of blood in your arteries and is thought of as the “gold standard" for carotid artery imaging.
Your doctor will also instruct you to stop taking certain medications that may be contraindicated with the procedure. You must inform your doctor of any allergies to medications, anaesthesia, latex, or contrast dye. Refrain from solids or liquids at least 8 hours prior to the procedure.
Procedure for Carotid Stenting
Carotid stenting is usually performed under local anaesthesia. During the carotid stenting procedure, your doctor inserts a stent into your carotid artery after performing an angioplasty. Angioplasty utilises a balloon inflated in the narrowed part of the artery to open it.
In general, during carotid angioplasty and stenting, your surgeon will make a surgical incision over your groin and place a catheter (a flexible tube) into the femoral artery. The catheter is then gradually guided to the blockage in your carotid artery. A filter is then placed, beyond the site of narrowing, to entrap small fragments of plaque detached from the walls of the artery. A tiny balloon is guided to the area of the blockage and inflated to widen the artery and increase blood flow. Carotid angioplasty is followed by the placement of a stent, a tiny mesh tube, inside the carotid artery. The stent is expanded and left in place to keep the artery open. The stent helps maintain the patency of the artery and prevents it from future narrowing.
Postoperative Care and Recovery
Following the procedure, you will be able to go home the same day or may have to remain in the hospital for a day or two. You will be able to start walking in 6 to 8 hours after the procedure. You may develop swelling, pain, or bruising at the catheter insertion site. Medications are provided as needed to address these. Blood thinning medications, such as Plavix and aspirin are also provided to prevent the formation of blood clots inside the stent. You can return to your normal activities in a week, but you should refrain from lifting heavy weights or engaging in certain strenuous activities for a defined period. A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
As with any surgery, complications may also occur with carotid angioplasty and stent placement. These include infection, serious bleeding due to rupture of the artery during catheter manipulation, embolic stroke due to accidental release of plaque fragments during the procedure, blood clots, and heart attack. A small risk of seizures and strokes also exists.
Before undergoing carotid angioplasty and stenting, your doctor will discuss the specific risks and potential benefits associated with the procedure, with you.
Benefits of Carotid Stenting
Some of the benefits of carotid stenting over open surgery include:
- No need for general anaesthesia
- Minimal discomfort
- Enhanced approach to narrowed or blocked arteries
- Lower risk of infection, nerve damage, and bruising
- Reduced hospital stay
- Quicker recovery
- Small skin incision