What is carotid artery stenting?

A specially designed guide wire with a filter, that acts similar to an umbrella, is placed beyond the area of narrowing in the carotid artery. Once in place, a small balloon is inflated for a few seconds to dilate the artery. Then, the stent is placed in the artery and opens to fit the size of the artery. A second balloon inflation is done to make sure the stent is completely expanded in your carotid artery. The stent stays in place permanently. After several weeks, your artery heals around the stent.

What can I expect during this procedure?

During the procedure, your physician will likely talk with you and may instruct you to squeeze a small toy or ball so they can monitor your brain function. In most instances, the procedure is performed while you are awake and alert.

Your will be given medications such as heparin to prevent clots, atropine to reduce the chances of your heart slowing down, and a local anesthetic to numb the catheter insertion area. Your physician then locates the narrow areas in your arteries by injecting a dye into your arteries and taking live x-rays. The dye does not allow x-rays to pass through, so physicians can see your arteries and use the live x-rays to guide them to the blockage.

Before inserting the stent, your physician will usually perform angioplasty. In angioplasty, a long, thin tube called a catheter with an attached balloon is inserted into a small incision or puncture over an artery in your arm or groin. The catheter is guided to the blockage site in your carotid artery using live x-ray imaging. You will not feel the catheters as they move through your arteries because there are no nerve endings inside your arteries.

At this point in the procedure, a small balloon, basket, or filter called an embolic protection device is inserted. This device helps to prevent strokes by catching the clots or debris that may break away from the plaque during the procedure. At the blockage site, your physician inflates and deflates the angioplasty balloon to flatten the plaque and widen the space where the blood flows through. After the artery is open, the catheter with the balloon attached is removed.

Using a different catheter, your physician guides a compressed stent to the same area in your carotid artery. Once the stent is in place it is released. The stent then expands to fit the artery. Your physician then removes the stent-carrying catheter and any embolic protection devices. Stents remain permanently in your carotid artery. Because stents are made of stainless steel or metal alloys, they resist rust. Carotid stenting usually takes about 1-2 hours but may take longer in some circumstances.

What should I expect after this procedure?

Immediately after the procedure, pressure is applied to the catheter insertion site in the groin or arm for 15 to 30 minutes to allow it to close and prevent bleeding. Sometimes a cork-like closure device or stitches that dissolve will be used. You may be instructed to stay in bed for the next several hours to be monitored for any complications, such as bleeding from the puncture site. You may be instructed not to lift anything more than about 5 to 10 pounds, after you return home, to avoid any pressure on the incision. You may also be instructed 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.

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