Carotid angioplasty and stenting are procedures that open clogged arteries and restore blood flow to the brain. They are often done to treat or prevent strokes. To either side of the spine are the carotid arteries. These are the main arteries that supply blood to your brain. They can become clogged with fatty deposits (plaque) that slow or block blood flow to the brain, a condition known as carotid artery disease that can lead to stroke. The procedure involves temporarily inserting and inflating a small balloon into the blocked artery to widen the area so that blood can flow freely to your brain. Carotid angioplasty is often combined with another procedure called stenting. Stenting involves placing a small metal coil (stent) in the blocked artery. The stent helps keep the artery open and reduces the chance that it will narrow again. Carotid angioplasty and stenting can be used when traditional carotid surgery (carotid endarterectomy) is not possible or is too risky.
What is Carotid Angioplasty?
Carotid angioplasty with stenting is a minimally invasive procedure in which a very small hollow tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. Once the catheter is in place, a balloon can be inflated to open the artery and a stent is placed. A stent is a cylinder-shaped tube made of a thin metal mesh structure that is used to keep the artery open. Because there is a risk of stroke from pieces of plaque that are dislodged during the procedure, a device, called an embolic protection device, may be used. An embolic protection device is a filter (like a small basket) that is attached to a guidewire to catch any debris that may come off during the procedure. While this procedure is widely performed, the long-term effects are still being studied.
Causes
Atherosclerosis, a condition in which plaque builds up in the arteries, is the most common cause of carotid artery disease. A similar buildup occurs in the blood vessels of the heart when someone has coronary artery disease. The plate contains clumps of:
- Cholesterol
- Fat
- Waste from cells
- Protein
- Calcium
Atherosclerosis can make your carotid arteries narrow and less flexible over time. The amount of blood supply to your organs is reduced as a result of this. Other disorders that cause arterial injury can also cause carotid artery disease.
Why is Carotid Angioplasty Performed?
Angioplasty and stenting of the carotid arteries can be effective stroke therapies or preventive options if:
- You have a carotid artery that is 70% or more blocked, especially if you have had a stroke or symptoms of a stroke, and you are not in good health to have surgery, for example, if you have heart disease or severe lung received radiation for neck tumors.
- You have already had a carotid endarterectomy and are experiencing re-narrowing after surgery (restenosis).
- Endarterectomy is difficult to do since the narrowing (stenosis) is difficult to reach.
- In some cases, carotid endarterectomy may be a better option than angioplasty and stenting to remove the buildup of fatty deposits (plaque) that are clogging the artery.
Procedure
Before
This includes over-the-counter medications like aspirin. You may need to stop taking some medications early, such as blood thinners. If you smoke, you will need to stop before the procedure. Talk to your healthcare provider if you need help quitting smoking.
You may need some tests before the procedure, such as:
- Blood tests, to detect anemia and infection.
- An electrocardiogram (ECG) is used to monitor the rhythm of your heart.
- A chest X-ray, to see your heart and lungs.
- Ultrasound of your neck, to see the carotid artery.
- Computed tomography (CT) angiography of the blood vessels of the neck and head.
Before the procedure, be sure to inform the medical team if:
- You have had a recent change in your health, such as a fever.
- You are or could be pregnant.
- You are allergic to iodine.
- Do not eat or drink after midnight before your procedure.
During
- An IV will be placed in your arm or hand before the procedure begins. An IV would be used to administer sedation. This will relax you and make you sleepy during the procedure.
- Hair may be removed in the area of your procedure. The area can be numbed with local anesthesia.
- A minor incision in a blood artery in the groin would be made by the doctor. And, into this cut, you'll put a long-thin cable. During the operation, the wire serves as a reference.
- Next, the doctor will insert a thin, flexible tube (catheter) over the wire. It has a small deflated balloon on the end. The catheter will be passed through the blood vessel to the carotid artery in the neck. Continuous x-ray images can be used to show exactly where the catheter is.
- The balloon will inflate within the narrow part of the carotid artery. This will stretch the open area.
- A mesh tube called a stent is inserted.
- The balloon will be deflated and the catheter will be removed to help hold the region open.
- The groin incision site will be closed and bandaged.
After
To avoid bleeding at the catheter insertion site, you must lie relatively still for several hours. You will be in the recovery area or the hospital room. After the procedure, you may have a carotid artery ultrasound. The catheter site may remain tender, swollen, and bruised for a few days. There may be a small area of discoloration or a small lump in the puncture area. You can take acetaminophen (Tylenol, others) in the recommended dose as needed for discomfort, or another medicine prescribed by your doctor. You may need to avoid strenuous activities and heavy lifting for 24 hours after the procedure.
Risk Factors
The risks of this procedure include:
- Infection
- Heavy bleeding
- Arterial injury
- Allergic reaction to contrast material.
- Kidney damage
- Stroke
- Heart attack
- The sudden closing of glasses
- Low blood pressure
- Cardiac arrhythmias, such as slow heart rate
