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Carotid Stenting: A Lifesaving Procedure for Blocked Arteries

3 November 2023

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Introduction

Carotid stenting is a medical procedure that plays a crucial role in preventing strokes and other severe health issues related to blockages in the carotid arteries. This blog will delve into the world of carotid stenting, exploring what it is, why it’s necessary, how it’s performed, its risks and benefits, and what to expect before and after the procedure. We’ll break down complex medical jargon and explain everything in simple language to help you understand this potentially life-saving treatment.

Understanding the Carotid Arteries

To comprehend carotid stenting, we need to start with a basic understanding of the carotid arteries. The carotid arteries are two major blood vessels located on either side of your neck. They are responsible for carrying oxygen-rich blood to the brain. Think of them as the highways that ensure your brain gets the nutrients and oxygen it needs to function properly.

Why Are Carotid Arteries Important?

The carotid arteries are crucial to our overall health because they supply blood to our brain, the control center for our entire body. When these arteries become blocked or narrowed due to a condition called atherosclerosis, it can lead to various health problems, with the most concerning being strokes.

A stroke occurs when blood flow to a part of the brain is obstructed, either by a blood clot or a piece of plaque breaking off from the carotid artery and getting lodged in a smaller vessel in the brain. This can result in brain damage or even death, depending on the severity and duration of the blockage.

What Is Atherosclerosis?

Atherosclerosis is the primary reason why carotid arteries become blocked. It’s a condition where fatty deposits (plaque) accumulate on the inner walls of the arteries, gradually narrowing the passageway. Over time, this can restrict blood flow, causing symptoms such as dizziness, blurry vision, and weakness on one side of the body. If left untreated, atherosclerosis in the carotid arteries can result in a stroke.

When Is Carotid Stenting Necessary?

Carotid stenting becomes necessary when a patient is diagnosed with carotid artery stenosis. Stenosis refers to the narrowing of an artery, which, in this case, occurs in the carotid arteries. A significant narrowing of these arteries can lead to reduced blood flow to the brain, increasing the risk of a stroke.

Your doctor may recommend carotid stenting if:

You’ve had a previous transient ischemic attack (TIA) or stroke.
You have severe carotid artery stenosis, typically defined as a 70% blockage or more.
You’ve experienced symptoms such as weakness or numbness on one side of your body, slurred speech, dizziness, or blurry vision, which may indicate reduced blood flow to the brain.

What Is Carotid Stenting?

Carotid stenting is a minimally invasive procedure that aims to open up a blocked or narrowed carotid artery and restore proper blood flow to the brain. This procedure is often an alternative to carotid endarterectomy, a more traditional surgical approach.

The stenting procedure involves inserting a small, flexible tube known as a catheter into an artery in your groin and threading it up to the blocked carotid artery. A stent, which is a mesh-like tube, is then placed at the site of the blockage to hold the artery open, much like scaffolding in a construction project. The stent expands and pushes the plaque against the artery wall, allowing for improved blood flow.

The Carotid Stenting Procedure

Now that you understand the basics, let’s dive into the specifics of the carotid stenting procedure. This will help you get a clear picture of what to expect if you or a loved one are going to undergo this potentially life-saving treatment.

Pre-Procedure Preparation

Before the procedure, your medical team will provide you with instructions on how to prepare. This typically includes fasting for several hours before the procedure. You’ll be asked to remove any jewelry or other accessories and change into a hospital gown.

Anesthesia

Carotid stenting is usually performed under local anesthesia. This means that you will be awake during the procedure, but the area around your groin will be numbed to ensure you don’t feel pain or discomfort.

Access Site

The doctor will make a small incision in your groin area to access the femoral artery. This is the point of entry for the catheter that will be used to navigate to the carotid artery.

Catheter Insertion

A thin, flexible catheter is inserted through the incision and carefully guided through the arteries until it reaches the site of the carotid artery blockage. Imaging techniques such as fluoroscopy, which uses X-rays, are employed to ensure accurate placement.

Stent Placement

Once the catheter reaches the carotid artery, the stent is positioned at the blockage site. The stent is typically wrapped around a deflated balloon. Inflating the balloon expands the stent and pushes the plaque against the artery wall, effectively opening up the artery. This is known as angioplasty.

Post-Stent Care

After the stent is in place, the catheter and balloon are removed. The stent remains to support the artery and maintain blood flow. The incision site in your groin is then closed, often with dissolvable sutures or a special closure device.

Benefits of Carotid Stenting

Carotid stenting offers several advantages compared to traditional carotid endarterectomy:

Minimally Invasive: Carotid stenting is less invasive and typically requires a shorter hospital stay.
Lower Risk of Complications: Since it’s a less invasive procedure, there’s a lower risk of complications, such as infection and bleeding.
Quicker Recovery: Patients usually recover more quickly after carotid stenting and can return to their regular activities sooner.
Suitable for High-Risk Patients: Carotid stenting is often a better choice for patients who may not be good candidates for surgery due to other health issues.

Risks and Complications

While carotid stenting is generally considered safe, like any medical procedure, it carries some risks and potential complications. It’s essential to be aware of these so you can make an informed decision and understand what to look out for during your recovery.

Stroke: Although the procedure is meant to reduce the risk of stroke, there is a slight chance of stroke during or after carotid stenting.
Restenosis: Over time, the stent can become re-narrowed due to the growth of new plaque. This may necessitate another procedure or surgery.
Allergic Reactions: Some patients may experience allergic reactions to the contrast dye used during the procedure.
Bleeding or Infection: There’s a small risk of bleeding or infection at the incision site in the groin.
Blood Clots: Blood clots can form on the stent or in the blood vessels, potentially causing issues.
Artery Damage: There’s a slight risk of damage to the carotid artery during the procedure.

It’s crucial to discuss these

potential risks with your healthcare provider to determine whether carotid stenting is the right choice for you. They will weigh the risks against the benefits and your specific medical condition to make an informed recommendation.

Recovery and Aftercare

Recovery from carotid stenting is typically quicker and less demanding than recovering from a carotid endarterectomy. After the procedure, you’ll be monitored in a recovery area for several hours. Here are some key points to consider during the recovery and aftercare process:

Observation: You will be closely monitored for any signs of complications, including changes in your blood pressure, heart rate, and neurological status.
Medications: Your healthcare provider may prescribe medications to help prevent blood clots, manage pain, or control other conditions like high blood pressure or diabetes.
Lifestyle Changes: It’s essential to make necessary lifestyle changes to reduce the risk of further blockages. This includes quitting smoking, eating a heart-healthy diet, and staying physically active.
Follow-Up Appointments: You’ll need to attend regular follow-up appointments with your healthcare provider to monitor your progress and ensure the stent is functioning correctly.
Risk Factor Management: Address underlying risk factors for atherosclerosis, such as high cholesterol, high blood pressure, and diabetes, through medication and lifestyle modifications.
Symptoms Monitoring: Pay close attention to any changes in your health, especially symptoms related to carotid artery disease or stroke, and report them to your healthcare provider promptly.

Conclusion: The Importance of Carotid Stenting

Carotid stenting is a vital medical procedure that can save lives by preventing strokes and minimizing the effects of carotid artery disease. This minimally invasive treatment option offers numerous benefits and is often suitable for high-risk patients who may not be candidates for traditional surgery.

Understanding the importance of the carotid arteries, the risks and benefits of carotid stenting, and the recovery process is crucial for making informed decisions about your healthcare. If you or a loved one is facing carotid artery disease, consult with a healthcare professional to determine the best treatment plan tailored to your unique needs.

By staying informed and working closely with your medical team, you can significantly reduce the risk of stroke and continue to lead a healthy and fulfilling life.

Our Doctors –

Dedicated IR Center for Vascular Problems in Madhya Pradesh

DR. SHAILESH GUPTA
MD, PDCC (INTERVENTIONAL RADIOLOGY) Consultant & Co-Director CVIC (Center Of Vascular & Interventional Care)

DR. ALOK KUMAR UDIYA
MD Radiology, PDCC (Neurointervention Radiology), PDCC ( HPB Intervention Radiology) FINR (Switzerland) & EBIR
Endovascular Surgeon & Consultant Interventional Neuroradiologist at Care CHL Hospital, Indore Co-director CVIC( center for vascular and interventional care)

DR. NISHANT BHARGAVA
Consultant Intervention Radiologist
MD Radiology, PDCC ( Neurointervention Radiology), FINR ( Fellowship in Neurointervention Radiology)
Co-director CVIC(Center for Vascular and Interventional Care)