A stent is a tube that the surgeon fixes in a blocked artery. Most sites of stent placement are carotid arteries and coronary arteries.
The carotid arteries are located on each side of the neck and are the main arteries supplying blood to the brain. The carotid arteries can be clogged by fatty deposits called plaque that slows or blocks the blood flow to the brain. This condition is known as carotid artery disease and can lead to a stroke if the brain does not get enough blood.
Carotid angioplasty and carotid stenting are minimally invasive procedures that open clogged carotid arteries to restore blood flow to the brain. They are often performed to treat or prevent strokes. These procedures involve temporarily inserting and inflating a tiny balloon into the clogged artery to widen the area that is clogged followed by stent insertion so that blood can flow freely to the brain.
Stenting involves placing a tiny metal-mesh tube called a stent in the clogged artery. This stent helps to keep the artery open and decreases the chance of it narrowing again. A carotid stent is permanent. There is a small 2-3% risk of the stent also getting clogged in the future. This usually happens within the first 6-9 months. If this happens, re-stenting is required. Other arteries can also narrow in the future, which would be treated with further stents.
Carotid stenting is a serious procedure requiring hospital admission. However, it is a commonly performed and relatively safe procedure done by a qualified doctor. Serious complications are rare, and the benefits of the procedure outweigh the risks. Some risks associated with carotid stenting include:
- Artery injury
- Allergic reaction to contrast material
- Death (rare)
- Heavy bleeding at the catheter insertion site
- Cardiac dysrhythmias/arrhythmias (abnormal heart rhythms)
- Heart attack
- Sudden vessel closure
- Low blood pressure
- Seizures (this is rare)
- Restenosis: Re-blockage of the artery due to a clot in the stent.
- Kidney damage from dye used for X-rays (higher risk in people who already have kidney disease)
Why are carotid angioplasty and carotid stenting performed?
Carotid surgery (endarterectomy) is an older and effective way to treat narrowed or blocked arteries. Carotid angioplasty and stenting procedures are a good alternative to carotid surgery.
- 70% or more of the carotid artery is blocked.
- The patient has a stroke or stroke symptoms.
- The patient is not in good health to undergo surgery.
- Restenosis: If the patient had previously undergone a carotid endarterectomy and is experiencing new narrowing after surgery.
- The location of the narrowing stenosis makes surgery harder.
- The patient has received radiation for neck tumors.
Carotid angioplasty and stenting are less invasive and use only a small incision. Therefore, the recovery time may be shorter. The risks of general anesthesia are also avoided.
In some cases, 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 safest for the patient.
How are carotid angioplasty and carotid stenting performed?
Carotid angioplasty and stenting are performed in a hospital’s catheterization laboratory or cath lab. The patient would be conscious during the procedure but would be given local anesthesia to numb the catheter insertion site.
During angioplasty, a thin tube called the catheter is inserted into an artery, usually through the femoral artery in the groin area. It has a tiny, deflated balloon on the end. The catheter will be guided through the blood vessel to the carotid artery in the neck where the blockage is present. This is accomplished with the guidance of live X-ray imaging.
Contrast material is injected into the carotid artery through the catheter. The contrast material may cause a temporary warm feeling on one side of the face. Contrast material provides a detailed view of the narrowed artery and blood flow to the brain.
The balloon is inflated 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. A tiny umbrella-like filter called an embolic protection device is inserted beyond the narrowing to catch the debris that breaks off. This greatly reduces the risk of stroke during the procedure.
Then, the physician will place a tiny metal mesh tube called a stent to help keep the artery from narrowing again. The stent may be coated in a drug that is released slowly over time to help prevent restenosis. The balloon is deflated, and the filter and catheter are removed after stenting. The incision site in the groin is closed and bandaged. 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. Patients are discharged with information about activities they may need to limit for a certain period.
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Aziz F. Carotid Artery Stenting. Medscape. https://emedicine.medscape.com/article/1839544-overview
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