Once a stent is placed in a carotid artery, the stent permanently stays inside the artery.
- Once placed, the stent permanently stays inside the artery. There is a 2-3% risk of repeat narrowing if the stent also gets blocked in the future. This usually happens within the first 6-9 months. If this happens, the stent will be replaced.
- The carotid arteries are located on each side of the neck. They are the main arteries supplying blood to the brain. The carotid arteries can be clogged by fatty deposits or plaques that narrow their lumens. This condition is known as carotid artery disease and can lead to stroke if the brain does not get enough blood.
- Carotid angioplasty and carotid stenting are minimally invasive procedures that widen the openings of the clogged carotid arteries to restore blood flow to the brain. They are often performed to treat or prevent strokes. They involve temporarily inserting and inflating a tiny balloon into the clogged artery to stretch and widening the area that is clogged so that the blood can flow freely to the brain.
- Carotid angioplasty is often accompanied by another procedure called stenting. Stenting involves placing a tiny metal-mesh tube called a stent in the clogged artery. This stent helps keep the artery lumen patent and reduces the risk of it narrowing again.
Why are carotid angioplasty and carotid stenting performed?
Carotid surgery (endarterectomy) is an older and effective procedure to treat narrowed or blocked arteries. Carotid angioplasty and stenting procedures are good alternatives to a carotid surgery.
Carotid angioplasty and stenting may be appropriate for stroke prevention or stroke treatment when
- 70% or more of the carotid artery is blocked.
- The patient has a stroke or exhibits stroke symptoms.
- The patient is not in good health to undergo surgery.
- The patient had restenosis (new narrowing after having undergone a carotid endarterectomy).
- The location of the stenosis makes the surgery difficult.
- The patient has received radiation for neck tumors.
Carotid angioplasty and stenting are less invasive and use only a small incision. Because of this, the recovery time may be shorter. The risks of general anesthesia are also avoided.
In some cases, a carotid endarterectomy might be a better choice than angioplasty and stenting to remove the plaque clogging the artery. The doctor would decide which procedure is the safest for the patient.
How are carotid angioplasty and carotid stenting performed?
Carotid angioplasty and stenting are performed in a hospital’s catheterization laboratory (cath lab). The patient would be conscious during the procedure, but the doctor would give local anesthesia to numb the catheter insertion site.
During the procedure:
- During an angioplasty, the doctor inserts a thin tube called a catheter into an artery, usually the femoral artery in the groin area. It has a tiny, deflated balloon on the end.
- The catheter will be threaded through the blood vessel up to the carotid artery in the neck where the blockage is present. This is accomplished with live X-ray imaging guidance.
- The doctor injects a contrast material into the carotid artery through the catheter.
- The contrast material may cause a temporary warm feeling on one side of your face.
- The contrast material provides a detailed view of the narrowed artery and blood flow to the brain.
- The doctor inflates a balloon inside the narrow part of the carotid artery to push the plaque to the sides of the artery wall and expand the artery.
- When the balloon opens, plaque and other debris may break free. They then insert a tiny umbrella-like filter called an embolic protection device beyond the narrowing to catch the debris that breaks off. This is done to greatly reduce the risk of a stroke during the procedure.
- Then, the doctor will place a stent to help keep the artery from narrowing again. They may coat the stent in a drug that is released slowly over time to help prevent restenosis.
- They deflate the balloon and remove the filter and catheter after stenting. They close and bandage the incision site in the groin area. The procedure typically takes about 2-3 hours.
After the procedure:
- The patient may be required to stay in the hospital for 1 or 2 days.
- Then the patient is discharged with information about activities that they may need to limit for some time.
What are the complications of carotid angioplasty and carotid stenting?
Serious complications are rare, and the benefits of the procedure outweigh the risks.
Some risks of this procedure include:
- Infection
- Artery injury
- Stroke
- Brain damage
- Allergic reaction to contrast material
- Death
- Heavy bleeding at the catheter insertion site
- Cardiac dysrhythmias/arrhythmias (abnormal heart rhythms)
- Heart attack
- Sudden vessel closure
- Low blood pressure
- Seizures (rare)
- Restenosis (re-blockage of the artery due to a clot in the stent)
- Kidney damage due to the contrast dye (higher risk in people who already have kidney disease)