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PATIENT INFO - CAROTID ANGIOPLASTY AND STENTING
Interventional cardiologists, radiologists or vascular surgeons perform carotid artery angioplasty to open the clogged arteries in your neck to prevent or treat stroke. They use a long, thin tube called a catheter that has a small balloon on its tip. They inflate the balloon at the blockage site in the carotid artery to flatten or compress the plaque against the artery wall.
Carotid angioplasty is often combined with the placement of a small, metal, mesh-like device called a stent. When a stent is placed inside of a carotid artery, it acts as a support or scaffold, keeping the artery open. By keeping the carotid artery open, the stent helps to improve blood flow to the brain. Carotid angioplasty and stenting are usually performed in patients either because they are not candidates for the traditional surgery (carotid endarterectomy) or because the procedure is felt to be less risky than the traditional surgery.
Why it's done
Carotid angioplasty and stenting is most often used only when the patient is too ill to have carotid endarterectomy. Other factors may make angioplasty better choice for treatment. These include which part of the carotid artery is narrowed or whether someone has had neck surgery in the past.
- You have a history of heart problems, such as congestive heart failure, unstable angina or a failed stress test.
- You have a carotid artery with a 70 percent blockage or more, especially if you've had a stroke or stroke symptoms, and you aren't in good enough health to undergo surgery — for example, if you have severe heart or lung disease or had radiation for neck tumors.
- You've already had a carotid endarterectomy and are experiencing new narrowing after surgery (restenosis).
- The location of the narrowing (stenosis) is difficult to access with endarterectomy.
Risks:
Risks of carotid angioplasty and stent placement are:
- Allergic reaction to dye.
- Blood clots or bleeding at the site of surgery.
- Brain damage.
- Clogging of the inside of the stent (in-stent restenosis).
- Heart attack.
- Kidney failure (higher risk in people who already have kidney problems).
- More blockage of the carotid artery over time.
- Seizures (this is rare).
- Stroke is more likely with carotid artery angioplasty than with carotid endarterectomy.
Before the procedure
- Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
- Notify your doctor if you are sensitive to or are allergic to any medications, iodine, latex, tape, contrast dye, or anesthetic agents (local and general).
- Notify your doctor of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
- Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications prior to the procedure.
- If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
- You will be asked to fast for eight hours before the procedure, generally after midnight.
- Your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.
- You may receive a sedative prior to the procedure to help you relax.
- Notify your doctor if you have a pacemaker.
- If you smoke, you should stop smoking as soon as possible prior to the procedure. This may improve your chances for a successful recovery from surgery and benefit your overall health status, as smoking increases clot formation in the blood.
- If your doctor determines that carotid artery angioplasty with stenting is the appropriate treatment for your carotid artery disease, you may be started on medication to help prevent more blockage in the carotid arteries such as aspirin and clopidogrel (Plavix) before the procedure.
- Based on your medical condition, your doctor may request other specific preparation.
During the procedure
Once you're sedated, your doctor makes a puncture in an artery, usually the femoral artery in the groin area. The following steps describe the angioplasty and stenting procedure.
- A small tube (sheath) is placed into the artery – A catheter is then threaded through the tube to the narrowing in the carotid artery under X-ray guidance. You won't feel the catheter passing through the arteries because the insides of arteries don't have nerve endings.
- Contrast material is injected into the carotid artery through the catheter – The contrast material may cause a temporary warm feeling on one side of your face. Contrast material provides a detailed view of the narrowed artery and blood flow to the brain.
- An umbrella-shaped filter is placed – The filter (embolic protection device) is inserted beyond the narrowing to catch any debris that may break off from the narrowed area of artery during the procedure.
- The balloon is inserted into the narrowed area – and inflated to push the plaques to the side and widen the vessel.
- A small metal mesh tube (stent) may be placed in the newly opened vessel – The expanded stent serves as a scaffold that helps prevent the artery from narrowing again.
- The filter, sheath and catheter are removed – Pressure is applied to the small catheter insertion site to prevent bleeding.
When the procedure is done, you lie still in one position while pressure is applied to the site to stop bleeding. You will then be taken to the recovery area.
After the Procedure:
After the procedure you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) or your hospital room.
At home—carotid angioplasty with stenting
Once at home, you should monitor the injection site for bleeding. A small bruise is normal, as is an occasional drop of blood at the site.
If the groin or arm was used, you should monitor the leg or arm for changes in temperature or color, pain, numbness, tingling, or loss of function of the limb.
You may be advised not to do any strenuous activities or take a hot bath or shower for a period of time after the procedure.
Your doctor may want to schedule you for follow-up duplex ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans to monitor the carotid arteries in your neck for a prescribed period of time.
MRI is a diagnostic procedure used for many different conditions. Because of the magnet used in the MRI machine, the presence of metal in or on a patient can affect the quality of the test. If you receive a stent, you may still undergo MRI without damage to your stent. Your doctor will most likely suggest that you not undergo an MRI for a month or so after your procedure unless there is an emergency situation.
Notify your doctor to report any of the following:
- Fever and/or chills.
- Increased pain, redness, swelling, or bleeding or other drainage from the groin injection site.
- Coolness, numbness and/or tingling or other changes in the affected extremity.
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation
Advantages of carotid angioplasty and stenting include:
- Better access to narrowed arteries.
- Less discomfort.
- No general anesthesia needed.
- Reduced risk of wound complications, nerve injury and bruising.
- A shorter hospital stay and recovery time.
- A smaller incision.