WHAT ARE CAROTID ANGIOPLASTY AND STENTING?
Carotid angioplasty and stenting are procedures that open blocked arteries, to allow blood flow to the brain. These procedures are usually done to treat or prevent strokes. Carotid arteries are the main arteries supplying blood to the brain and are located on each side of your neck.
Blockage or narrowing of carotid arteries is caused by fatty deposits (plaque) and the condition is known as carotid artery disease (CAD; also known as ‘atherosclerosis’), which can lead to a stroke.
Carotid arteries clogging need an emergency intervention so that blood can flow freely to the brain. A combination of carotid angioplasty with stenting can offer relief when endarterectomy (a traditional carotid surgery) seems not possible, maybe due to its risk or patient unpreparedness.
Carotid angioplasty involves temporarily inserting and inflating a tiny balloon into the blocked artery to widen it for free flow of blood. It is often combined with another procedure called stenting.
Stenting involves placing a small metal coil (stent) in the blocked artery. The stent helps to keep the artery open and reduces the chance of it narrowing again.
REASONS FOR CAROTID ANGIOPLASTY AND STENTING
Carotid angioplasty and stenting are minimally-invasive procedures and non-surgical methods carried out for the following reasons:
- If you have a carotid artery blockage of 70% or more or had a stroke or stroke symptoms, and you aren’t in the right health to undergo surgery, angioplasty maybe your best option.
- If you are experiencing a recurrence of carotid artery narrowing after carotid endarterectomy.
- If the location of the narrowing (stenosis) poses difficulty to access with endarterectomy.
SYMPTOMS OF CAROTID ARTERY STENOSIS
- Vision problems.
- Blood clot (formed in the narrowed carotid artery).
- Loss of neurologic functions in specific areas of the body.
- Stroke (blood clot can travel to the brain, blocking brain’s blood supply).
RISK FACTORS OF CAROTID ARTERY STENOSIS
Certain factors can raise your risk of carotid narrowing. They include:
- Overweight (obesity).
- High intake of cholesterol.
- High blood pressure (hypertension).
- Family history of stroke.
COMPLICATIONS OF CAROTID ARTERY STENOSIS
The major complications of carotid artery disease include:
This is the number one complication of carotid artery narrowing. It occurs when the blood supply to the brain is partly or blocked.
- Transient Ischemic Attack (TIA)
This occurs when a tiny clot of blood briefly blocks a vessel supplying blood to the brain. TIA causes the same symptoms as a stroke.
RISKS ASSOCIATED WITH CAROTID ANGIOPLASTY AND STENOSIS
Despite the benefits of carotid angioplasty and stenting, the procedure functions not without risks. These risks include:
- Heart attack.
- Heavy bleeding.
- Injury to the artery.
- Low blood pressure.
- Damage to the kidney.
- Sudden blood vessel closure.
- Restenosis (return of the blockage).
- Allergic reaction to the contrast materials.
- Heart arrhythmias (such as slow heart rate).
Your risks usually vary based on your overall health and the severity of your condition. The following may increase your risk of complications:
- If you have symptoms from carotid stenosis.
- If you previously had a stroke or mini-stroke (TIA).
- Other medical conditions of yours, including diabetes.
PREPARATION FOR CAS PROCEDURES
- Talk to your doctor about how to prepare for the procedures.
- You may need to stop taking some medications ahead of time, such as blood thinners.
- Stop smoking before the procedure (talk with your doctor, you need help).
- You may do some tests before the procedure, including:
- Chest x-ray, to view your heart and lungs.
- Blood tests, to check anemia and infection.
- Ultrasound of your neck, to view your carotid artery.
- CT angiogram of the blood vessels of the neck and head.
- An electrocardiogram (ECG), to check your heart rhythm.
Before the procedure, the medical team will ask if you:
- Are allergic to iodine.
- Are pregnant or might be pregnant.
- Have ever had any problem with sedation.
- Have a health condition, such as fever or headache.
- Have ever had any bad reaction to intravenous contrast dye.
- Don’t eat or drink after midnight the night before the procedure.
- Take any other instruction given by your doctor or medical team.
PROCEDURE FOR CAROTID ANGIOPLASTY AND STENTING
CAS procedure is performed by a specialist doctor with a team of nurses. The procedure may last for 1⅟₂─2⅟₂ hours. The procedure is as follows:
- An IV will be put in your arm or hand before the procedure starts.
- You will be given sedation through the IV line, to make you relax and sleep during the process.
- Your hair will be procedure will be removed and the area numbed with local anesthesia.
- Your doctor will make a small cut on your groin.
- The surgeon places a catheter through the cut into an artery and carefully moves it up to your neck, to the blockage in your carotid artery (moving x-ray pictures (fluoroscopy) are used to see the artery, as well as guide the catheter to the correct position).
- The surgeon then moves a wire through the catheter, to the blockage.
- The doctor will push another catheter, with a very small deflated balloon on the end, over this wire and into the blockage.
- He then inflates the balloon.
- The balloon presses against the inside wall of your artery and opens the artery to allow more blood flow to your brain.
- A stent (wire mesh tube) is inserted at the same time as the balloon catheter in the blocked area.
- The stent will expand with the balloon.
- The stent is then left in place, to help keep the artery opens.
- The doctor finally removes the balloon.
- The surgeon then closes the incision site and bandages it.
After The Procedure,
- You’ll sleep several hours in the recovery room.
- You may be sleepy and confused upon waking up.
- Your healthcare team will watch your vital signs repeatedly, such as your heart rate and breathing.
- You will be given a pain relief medicine.
- To prevent bleeding from the incision site, you may have to lie down flat for several hours after the procedure.
- You may stay in the hospital overnight.
- When you are fit to go home, you will need someone to drive you home.
- Rest and avoid strenuous exercise for at least 24 hours.
While at home, call your doctor immediately, if you experience the following:
- Chest pain.
- Redness and/or warmth at the incision site.
- Blood or fluid leakage from the incision site.
- Pain or swelling at the incision site, which seems to get worsened over time.
- Follow all your doctor’s instructions.
- Honor all follow-up appointments.
Percutaneous trans-luminal angioplasty and stenting for the carotid artery, is a safe and reliable procedure for carotid restenosis after Everson endarterectomy treatment.
Percutaneous transluminal angioplasty (PTA) is a procedure that can open up a blocked vessel, using a catheter with a balloon to restore normal blood flow when the balloon is inflated.
It is a minimally invasive procedure, nonsurgical, with less risk than an endarterectomy. However, the patient is in the best position to decide which alternative is best for him/her, since both have their pros and cons.
- Is angioplasty a major surgery?
Angioplasty is not major surgery. These procedures are most often performed under conscious and moderate sedation in a cardiovascular catheterization laboratory, also known as a cath lab. The procedure is done by threading a thin tube (catheter) through a small incision in an artery.
- What does ‘percutaneous’ mean in medical terms?
‘Percutaneous’ simply entails something going ‘through the skin’.
- Can you live with one blocked carotid artery?
A network of blood vessels at the base of the brain (called the circle of Willis) can often supply the necessary blood flow. Many people function normally with one completely blocked carotid artery, provided they haven’t had a disabling stroke.
- Can carotid arteries be stented?
Carotid artery stenting is done by inserting a slender metal mesh tube (called a ‘stent’) which expands inside your carotid artery, to increase blood flow in areas blocked by plaque.
- What percentage of carotid artery blockage requires a stent?
By clinical guidelines, an artery should be clogged at least 70%, before a stent could be placed.