Carotid Artery Stenting

Patients

Carotid artery stenting (CAS) is a procedure that is intended to reopen the blocked section of the carotid artery using a small mesh, metal tube. CAS is a minimally-invasive alternative treatment for patients who are at high risk for surgery and who meet other specific criteria. In CAS a small incision is made into an artery located in the groin, arm, or wrist through which tiny devices are inserted. The devices are guided to the blocked area of the carotid artery using x-ray equipment. The patient remains awake while the physician performs the intervention and monitors the function of the brain. Patients who receive a carotid stent usually are well enough to leave the hospital and go home within one to two days following the procedure.

 

Carotid Artery Stenting Procedure

After the physician makes an incision in the artery in the groin, arm or wrist, a guide catheter - a specialized small, hollow tube with a guide wire inside it - is inserted into the incision site. Using x-ray equipment, the physician moves the guide catheter through blood vessels to the blocked section of the carotid artery.

Before inserting the stent, the physician will place an embolic protection device - a collapsible umbrella-like filter attached to a guide catheter - past the blocked section and open it up. The opened filter is designed to reduce the risk of stroke by capturing plaque that may become dislodged during the procedure.

Next, the physician may enlarge the blocked section of the artery in a procedure called angioplasty. During angioplasty a small, deflated balloon is delivered through a catheter to the blocked area. Once the balloon is positioned over the narrowed part of the artery, it is inflated. This pushes the plaque buildup against the artery wall, widening the artery and restoring blood flow. The balloon is then removed.

Finally, a self-expanding carotid stent is delivered to the blocked area of the carotid artery. Once the stent is deployed it is expanded with a balloon to make sure it is firmly in place. After the balloon is withdrawn, the filter is collapsed and removed, and the incision is closed. The stent remains in place to keep the artery open.

Post-Procedure

Before leaving the hospital, your doctor and nurse will probably discuss:

• How to care for the wound where the incision was made
• How to use home monitoring equipment to take your blood pressure twice a day for about a month
• The need for taking anti-clotting medication
• When you can resume normal activities
• Instructions concerning diet, exercise, and other behaviors that affect carotid artery disease