Carotid Angioplasty

Carotid angioplasty and stenting are a procedure that opens blocked arteries that prevent blood flow.

The carotid arteries are found on each side of your neck and are the main arteries supplying blood to your brain.

The procedure includes temporarily inserting and inflating a tiny balloon in the area where your carotid artery is clogged to widen it.

Carotid angioplasty is often combined with the addition of a small metal coil called a stent in the clogged blood vessel. The stent helps prop the artery open and reduces the chance of narrowing one more.

Carotid angioplasty and stenting may be used when traditional carotid surgery isn't feasible or if it is too risky to be performed.

Here are the most common reasons to receive a carotid angioplasty and stenting.

Carotid angioplasty and stenting may be an appropriate treatment for stroke or stroke prevention if:

• You have a carotid artery with a 70% blockage or more,
• if you already have had a carotid endarterectomy and are experiencing new narrowing after surgery (restenosis)
• if the location of the narrowing (stenosis) is not easy to access with the endarterectomy.

In some cases, traditional carotid surgery (carotid endarterectomy) may be recommended to remove the buildup of plaques that is narrowing the artery. In other cases, angioplasty and stenting are the better solutions.

As with any surgical procedure, complication is likely. The following are some of the potential risks that might be associated with carotid angioplasty and stenting:

Stroke or ministroke (transient ischemic attack, or TIA)

During angioplasty, blood clots that may form on the catheters can break loose and travel to your brain. Blood thinners are given to reduce this risk.

A  stroke can also occur if plaques in your artery are dislodged when the catheters are being threaded through blood vessels.

Other risks include bleeding, the formation of blood clots within stents which can cause strikes and a new narrowing of the carotid artery or restenosis. 

To prepare for a carotid angioplasty and stenting , your doctor will review your medical history and also performs a physical exam.

One of the following examinations may be performed as well:

Ultrasound

To produce images of the narrowed artery and of the flow of blood to the brain.

A Magnetic Resonance

Angiogram to provide highly detailed images of blood vessels by using their radiofrequency waves in a magnetic field by using X-rays with contrast material.

Carotid angiography can also be carried out where contrast material is injected into an artery so that vessels can be examined. You will be given instructions on what to eat or drink before an angioplasty. Your preparation may be different if you are already staying at the hospital prior to your procedure.

The night before your procedure

Follow your doctor's instructions about making adjustments to your current medications, take approved medication with only small sips of water and arrange for transportation from home because you will not be able to drive yourself home.

Read on to learn more about what to expect before, during, and after your carotid angioplasty and stenting.

Carotid angioplasty is a nonsurgical procedure because it is less invasive than surgery is.

Your body is not cut open except for a very small cut in a blood vessel in your groin. General anesthesia is not required. Your will be awake for the entirety of this procedure. You will also receive fluids and medications to relax you through an intravenous catheter.

Before the procedure

You're taken to an X-ray imaging room and asked to lie on a procedure bed. You'll rest your head in a cup-shaped area to help you remain comfortable and still while pictures of the carotid artery are taken.

Your groin is shaved and prepared with an antiseptic solution, and a sterile drape is placed over your body. A local anesthetic is injected into your groin to numb the area. Small electrode pads are placed on your chest to monitor your heart rate and rhythm during the procedure.

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 the 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

To avoid bleeding from the catheter insertion site, you need to lie relatively still for several hours, either in the recovery area or in your hospital room. After the procedure, you may receive an ultrasound of your carotid artery.

Most people are discharged from the hospital within 24 hours after the procedure. 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 area of the puncture. You may take acetaminophen (Tylenol, others) in the recommended dose as needed for discomfort, or other medication as prescribed by your doctor.

You may need to avoid strenuous activity and heavy lifting for 24 hours after the procedure.

Understanding the results of your carotid angioplasty and stenting will be made possible by your doctor.

For most individuals, carotid angioplasty and stenting increases blood flow through the previously blocked artery and reduces the risks or symptoms or stroke.

It is important to seek medical care if your signs and symptoms return, such as trouble walking or sleeping, numbness on one side of your body or other symptoms similar to those you had before.

Carotid angioplasty and stent are not the appropriate treatment for everyone. Your doctor can determine if the benefits outweigh the potential risks.

Because carotid angioplasty is a fairly new procedure, long-term results are still under investigation. Talk to your doctor about what results you might expect and what type of follow-up is needed after the surgery.

Lifestyle changes can help you achieve good results:

• don't smoke,
• lower your cholesterol and triglyceride levels,
• maintain a healthy weight,
• exercise regularly

Control other conditions, such as:

• diabetes,
• high blood pressure
• sleep apnea.