Carotid Stenting

Carotid atherosclerotic disease occurs when fatty deposits (plaques) clog the blood vessels that deliver blood to the brain and head (carotid arteries). Similarly the blockage can happen in vertebral artery as well. The blockage increases the risk of stroke, a medical emergency that occurs when the blood supply to the brain is interrupted or seriously reduced. The first sign that one have for this condition may be a stroke or transient ischemic attack (TIA). Mild and moderate stenosis (unto 70%) is treated with medical therapy but if stenosis increases to more than 70% in symptomatic cases and more than 80% in asymptomatic patients then only secondary prevention is recommended by surgery or intervention.

There are two options of dealing this blockage in the brain arteries: 1- Surgery: carotid Endarterectomy an old, conventional method and 2- Intervention: Carotid Stenting and angioplasty.

When do you need carotid angioplasty and stenting?

• 70% blockage or more in the carotid artery, especially if there has been a stroke or symptoms of a stroke
• Restenosis – This is a condition that develops in patients who already had a carotid endarterectomy, and are now suffering new narrowing as a result of the procedure (restenosis)
• Endarterectomy is difficult to perform because finding the location of the narrowing (stenosis) is difficult
• In certain situations, carotid endarterectomy may be a better option for removing fatty deposits (plaque) that have clogged the artery than angioplasty and stenting.

What are the risk factors for patients with pre-existing conditions?

Pre-existing conditions can cause complications during the surgery. Hence, it’s important to discuss your existing ailments with your surgeon to understand and mitigate the risks posed by these medical conditions during the procedure.

Here are the major risk factors associated with carotid angioplasty and stenting:

Stroke- Blood clots that develop during angioplasty can break free and go to your brain. To lessen this risk, blood thinners will be given to you during the procedure. If plaque in your artery is dislodged when the catheters are threaded through the blood vessels, it can lead to chances of a stroke.

A new narrowing of the carotid artery (restenosis) - One common disadvantage of carotid angioplasty is the possibility that your artery can constrict again within months of the treatment. To lower the risk of restenosis, special drug-coated stents may be inserted during the procedure.

Clots in the blood- Even weeks or months after angioplasty, blood clots can grow within stents. These clots have the potential to cause a stroke or worse. To reduce the risk of clots forming in your stent, make sure you take aspirin and other drugs exactly as directed.

Bleeding- You may experience bleeding in the region where the catheters are inserted. This usually results in bruising, although in some cases significant bleeding can occur, necessitating a blood transfusion or surgical operations.