Heart Hospital - Procedures
Carotid Artery Stenting

What is carotid artery disease?

Carotid artery disease is a form of peripheral arterial disease (PAD). PAD refers to the narrowing and hardening of peripheral (other than heart) arteries by a fatty material called plaque. If one or both of the arteries that provide blood flow to your head (the carotid arteries) becomes narrowed and is left untreated, you could be at higher risk for a stroke or a mini-stroke (TIA-transient ischemic attack).

The primary treatment method for carotid artery disease, to prevent a stroke, is known as carotid endarterectomy (CEA). A newer procedure that sometimes can be used instead of carotid endarterectomy (CEA) is known as carotid artery stent (CAS).

What is a carotid artery stent?

This procedure, like carotid endarterectomy (CEA), helps give more space for blood to flow through a carotid artery. The stent (a medical grade stainless steel mesh tube) is placed in the artery to help hold and reinforce the walls of the artery open.

Where is a carotid artery stent procedure performed?

In the Angiography Lab in the Medical Imaging department of the hospital.

How is a carotid artery stent placed?

The procedure is performed while you are awake and alert. This is necessary to monitor you neurological status during the procedure. Before the procedure begins, you will be connected to a monitor that shows your heart rate and blood pressure. You may also be instructed to squeeze a small toy or ball to help monitor your brain function during the procedure.

Your physician will numb the catheter insertion area by giving you a local anesthetic. They may give you other medications to reduce the chances of your heart slowing down. Next a tiny puncture is performed in the groin (upper part of the leg). Then, by using a wire, a catheter (a long thin tube) will be advanced through the vascular system and up into the neck artery (carotid artery). You will not feel the catheters as they move through your arteries because there are no nerve endings inside your arteries. Your physician then injects a dye into your arteries and takes X-rays to locate narrow areas in your arteries. If the narrow area can be opened safely, then your physician will proceed with the procedure.

First your physician may insert a small balloon, basket, or filter called a distal embolic protection device, through the catheter. This device helps to prevent a stroke by catching clots or debris that may break away from the plaque during the procedure.

Next your physician will perform an angioplasty. A small balloon is inserted through the catheter and is inflated and deflated within the carotid artery to flatten the plaque within the artery wall.
Next, the stent is placed within the artery. A sheath covering the stent is then removed to allow the stent to self-expand.
 

After the stent is expanded, a balloon may be inflated to additionally expand the stent and further flatten the plaque within the artery wall.

Once the stent is fully expanded, the balloon is deflated and removed.

The stent stays in place permanently and helps to increase blood flow by holding the artery wall open. The inside lining of the artery will grow over the stent to create a smooth surface inside your artery within a few weeks.

How long does the carotid artery stent procedure take?

Typically, the procedure is performed one day (and takes approximately 1- 2 hours, sometimes longer) and you stay overnight in the hospital and are discharged home the next day.

What happens after the procedure?

Immediately after the procedure, your physician or a nurse applies pressure to the insertion site for 15 to 30 minutes to allow it to close and prevent bleeding. To close the incision, your physician may use, instead, a cork-like closure device or stitches that dissolve.

You will be instructed to stay in bed for the next several hours so that the puncture site heals. You will be watched for any complications, such as bleeding from the puncture site.

You may be instructed not to lift anything more than about 10 pounds, for the first week after you return home, to avoid any strain on the incision. Your physician may also instruct you not to take a bath for a few days (but showers are fine), and to drink plenty of water to help flush the dye out of your system.

8/3/2008