The carotid arteries are blood vessels on each side of the neck that carry oxygen-rich blood to the brain, head and face. When there is narrowing or blockage of one or both of the carotid arteries it is called Carotid Artery Disease (CAD). CAD is common in the United States and is the leading cause of stroke. To treat CAD, doctors will sometimes perform Carotid Artery Stenting (CAS). CAS is a minimally invasive surgical procedure where a stent (metal plastic tube) is placed within the opening of the carotid artery. After the stent it placed successfully, blood flow will be improved and the risk of stroke is significantly decreased.
Risks of carotid stenting
• Stroke – Blood clots can form during a CAS and if they travel to the brain it can cause a stroke. This is the most common risk during the stenting and occurs between 2% and 10% of all carotid stenting procedures performed.
• Infection – Infection from carotid stenting is a very rare but potentially lethal risk.
• Blood clot – During the weeks and months after CAS, blood clots can form within the stent. For this reason, doctors will prescribe blood thinning medications such as baby aspirin or Plavix to decrease the chance of blood clots.
• Bleeding at the insertion area – Damage to the blood vessel where the catheter is placed can cause bleeding and should therefore be monitored closely after the procedure is completed.
• Intracranial hemorrhage – Postoperative intracranial hemorrhage (ICH) after carotid artery stenting is a very rare but potentially fatal complication. This article published in 2009 concluded that good neurocranial care after stenting can be life-saving for those patients that experience ICH.
• Death – In addition to the immediate risk of death from surgery, patients are at a higher risk of death for years after having a stent placed in their carotid artery. A 2015 article published by JAMA Neurol estimated a mortality rate of 32% at 2 years after carotid artery stenting.
Benefits and risks of carotid stenting should be discussed in detail with the physician before the procedure is performed. Some patients are not good candidates for this procedure.
How to prepare for carotid stenting
• Blood thinners – Taking blood thinners as prescribed by a doctor is the most important preparation before carotid stenting. These will reduce the likelihood of a blood clot forming during and immediately after the procedure.
• Fasting – For patients that will be sedated, the general rule is 6 hours of fasting before surgery.
During carotid stenting
The physician will use a tube called a catheter to place the stent. He/she will insert the catheter into a large artery, usually the femoral artery in the groin, and guide it through the arteries to the carotid artery in the neck. To find the exact location of the blockage, the physician will put dye into the catheter which will show up on X-ray images.
Once the catheter has reached the blockage a very thing guide wire will be used to move a balloon and the stent to the carotid artery. Then the balloon will be inflated inside the stent to open the blocked artery. Afterwards, the balloon, guide wire and catheter are all removed and the physician will close the small incision at the insertion site. This procedure usually takes between one and two hours.
Recovery after carotid stenting
After the procedure the patient will be moved to a recovery room. The medical staff will monitor the patient’s heart rate, pulse and blood pressure. They will also check the catheter insertion site for bleeding. A bandage will be placed over the insertion site which may be sore for a few days and/or bruise. The patient will be released once they have recovered which may take up to two days.
After surgery the patient will be prescribed antiplatelet medications to help prevent stroke. Only light activity should be performed for the first two weeks. Eating healthy, being active and not smoking are important lifestyle changes that should be made to give the patient his or her best chances for a longer, healthier life. Any symptoms the patient may experience should be immediately reported the referring physician.
Carotid stenting in Houston
The Cardiology and Vascular Services Department at OakBend Medical Center has board certified surgeons with experience in minimally invasive surgeries and procedures. The Houston experts at OakBend Medical Center treat carotid artery disease to minimize your chances of stroke. Their physicians will work with you to help you manage and treat the disease before it has serious consequences. Their goal is to improve your health and quality of life. Many vascular conditions are quite manageable, if you see a physician early. Please contact them today for more information or to set up a consultation by calling 281-341-3000.