Having Carotid Artery Stenting
Understanding carotid artery stenting
Carotid artery stenting is a procedure to open up a narrowed carotid artery. Two carotid arteries on each side of the neck deliver blood to the brain. A stent is a tiny, metal mesh coil that props open the artery so that blood can flow freely. During the procedure, your doctor inserts a long thin tube called a catheter into an artery. This lets the doctor move instruments through the artery to put the stent in place. Stenting is often done with a procedure called angioplasty. For angioplasty, the doctor inflates a tiny balloon at the tip of the catheter at the blocked portion of the artery. The inflated balloon presses the plaque against the artery wall thereby opening the artery for better blood flow. The doctor then places the stent to help keep the artery open.
Why is carotid artery stenting done?
Carotid artery stenting is done to restore blood flow to the brain to prevent stroke. A stroke can occur if the artery becomes narrowed or a blood clot forms in the artery. This can block blood flow to part of the brain.
How is carotid artery stenting done?
Your doctor will need to talk to you during the procedure, so you’ll be awake the entire time.
Inserting the catheter
A surgical team member will clean the skin in the area of the insertion site with an antiseptic solution. Next, your doctor will numb it with local anesthetic.
The doctor will make a puncture usually in the femoral artery in the groin, although he or she m ay use an arm or even neck artery.
The doctor will insert an introducer sheath or tube into the puncture.
The doctor inserts the catheter into the sheath. Using X-rays as a guide, the doctor moves the catheter through the sheath and up through the aorta and into the carotid artery.
You will have an angiogram of the carotid artery. A carotid angiogram is a test that uses X-rays and a special fluid (called a contrast medium or dye) to help your doctor find blockages or other problems in the carotid arteries. Your doctor injects the contrast dye into the artery to show the location of the narrowed portion on X-ray. You may feel a warm sensation toward your head just after the dye is injected. Also, you may think you see some flashing lights. This is normal and will only last for a few seconds. If it persists, let your doctor know immediately.
Placing the filter
A filter or other protective device prevents pieces of plaque from being carried downstream into the brain and causing a stroke. The doctor uses the catheter to place the unopened filter in the artery and advance it past the narrowed area. He or she then opens the filter. It remains in place for the whole procedure. If narrowing is very severe, your doctor may need to widen the artery before the filter is put in place.
Opening the artery
The doctor will open or expand the narrowed artery if the narrowing is too tight to allow the stent to pass through. This is done using balloon angioplasty:
The doctor guides an uninflated balloon tipped catheter to the area that needs to be widened.
He or she then inflates the balloon, pushing the artery open. The balloon may need to be inflated and deflated several times to open the artery enough.
After the procedure is done, the doctor deflates and removes the balloon.
Placing the stent
A stent is a metal mesh coil that is used to expand a narrow artery and to keep it open.
The doctor guides the stent through the catheter to the site of the narrowing. He or she then expands the stent using balloon angioplasty. You may feel a slight pain in your neck during the balloon angioplasty.
Your doctor then removes the catheter and balloon, leaving the stent in place.
Checking the result
You will have another angiogram to compare with the one taken at the start of the procedure. Once your doctor is satisfied with the result, he or she will remove the filter and other instruments and close the insertion site.
Risks and possible complications
The risks of this procedure include:
Bleeding at the puncture site
Bleeding into the brain
Blood clot at the puncture site
Low blood pressure
Blood clot in the treated vessel
Reaction to contrast fluid
Heart rhythm problems, such as slow heart rate
Reblockage of the artery and possible need to get treatment again
May 29, 2017
Brott, TG. Guideline on the Management of Patients With Extracranial Carotid and Verebral Artery Disease. Circulation 92011); 124(4); pp. s54-s130, Carotid artery stenting and its complications. UpToDate.
Fetterman, Anne, RN, BSN,Sudheendra, Deepak, MD