Carotid Stenting Procedure
Carotid Stenting Procedure
The carotid arteries are located on each side of your neck and extend from your aorta in your chest to the base of your skull. These arteries supply blood to your brain. When plaque builds up and reduces blood flow in your carotid arteries, you have carotid artery disease. This is serious because clots can form on the plaque and block the flow to your brain, causing an ischemic stroke (a stroke caused by a blockage or blood clot), resulting in brain damage, disability or even death.
The most common causes of carotid artery disease are high cholesterol, high blood pressure, diabetes mellitus, atherosclerosis (build-up of plaque in blood vessels throughout the body, including the arteries that supply the heart), and smoking.
Physicians will recommend carotid artery stenting when an individual has significant blockage and/or disease in one or both of their carotid arteries. The aim of carotid stenting is to reduce the risk of having a stroke in the future due to carotid artery disease.
How to Prepare for a Carotid Stenting Procedure
Prior to scheduling your procedure, your physician may order:
- a duplex ultrasound exam of the carotid arteries
- a computed tomography (CT) scan or a magnetic resonance imaging (MRI) study, including examination of the major blood vessels in the head and neck (CT angiogram, CTA; or MR angiogram, MRA)
- Blood tests (usually complete blood count, blood chemistry, and coagulation studies)
- EKG (electrocardiogram)
In most cases, your physician will instruct you to take aspirin and clopidogrel (Plavix) for at least 5 – 7 days before the procedure. These medications keep your blood slightly thinner than usual and reduce the risk of blood clots forming when the stent is placed in the carotid artery, as well as in the days and months after the procedure.
Your physician may also ask you to take a cholesterol-lowering medication such as atorvastatin (Lipitor), simvastatin (Zocor), or pravastatin (Pravachol) for several weeks before the carotid artery stent is put in. These medications (“statins”) have been shown to decrease your risk for complications during your carotid stent procedure, as well as keeping plaque from building up in the vessel in the future.
It is extremely important to take your medications EXACTLY as ordered before your carotid artery stenting procedure. These medications not only help make the carotid stenting procedure as safe as possible, but they help ensure that the stent will be successful in keeping the artery open and reducing your risk of stroke. Use a chart, similar to the one below, to record the medications that you take before your cardiac stent procedure and provide to your doctor at all appointments.
The Day of Your Carotid Stenting Procedure:
- You should fast for six hours before your procedure
- You will be admitted to the Same Day Unit, please leave all valuables home
- An IV will be inserted into your arm for fluids
- You will be given a small amount of sedation during your procedure to help you relax but you will remain awake
During Your Carotid Stenting Procedure:
The procedure usually takes place in an angiography suite or catheterization lab. Before the procedure begins, your physician 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. In most instances, the procedure is performed while you are awake and alert.
Carotid stenting is usually performed under local anesthetic. The procedure involves passing microscopic wire and catheters inside the arteries under X-ray guidance. These are usually introduced via an artery in your groin, the femoral artery. Your physician guides the catheter to the blockage site in your carotid artery using live X-ray imaging. You will not feel the catheters as they move through your arteries because there are no nerve endings inside your arteries. At this point in the procedure, your physician may 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, your physician inflates and deflates the angioplasty balloon to flatten the plaque and widen the space where the blood flows through. You may feel a little discomfort in your neck at this time. Some patients may also feel a little light-headed. This can be corrected by fluid and medication if necessary. After the artery is open, your physician then removes the catheter with the balloon attached.
Using a different catheter, your physician guides a compressed stent to the same area in your carotid artery. Once the stent is in place, your physician releases it. The stent then expands to fit the artery. In most cases, your physician then uses a balloon catheter to further expand the stent.
Your physician then removes the stent-carrying catheter and any embolic protection devices. Stents remain permanently in your carotid artery.
Carotid stenting usually takes about 1-2 hours but may take longer in some circumstances.
After Your Carotid Stenting Procedure:
- You will be admitted to the hospital, probably the Intensive Care Unit for specialized nursing care. Your hospital stay will probably be 1-3 days
- Your blood pressure and heart rate will be checked often The nursing staff will also assess your speech and movements periodically
- The first few hours will require bedrest to prevent bruising or bleeding from your groin. Then you will be asked to move about.
- Stroke: A small number of people undergoing carotid stenting may have a stroke during or shortly after the procedure. Cholesterol deposits or other debris may be dislodged during the carotid stent procedure and travel to the brain, or rarely, bleeding in the brain may occur. While all possible safety precautions will be taken to prevent stroke during your carotid stent procedure, you should talk to your physician about your own individual risks for stroke.
- Bleeding: Occasionally a collection of blood accumulates around the artery in the groin but is rarely a major problem. This is called a hematoma. Brusing and mild tenderness at the puncture site is common.
- Allergic reaction to the X-ray dye: The dye used for the angiogram can sometimes cause damage to the kidneys, especially in people who already have kidney trouble.