Endovascular Carotid Stenting
How to say it: End-o-vaz-ku-larr Carr-aww-tid Stent-ing
Definition
An endovascular carotid stent is a mesh tube that is placed in a blood vessel in the neck. The stent will help to prop open the blood vessel and improve blood flow to the brain.
Reasons for Procedure
Plaque can build up on blood vessel walls. It can slow or block the flow of blood. The carotid artery supplies blood to the brain. Poor blood flow through the carotid can cause damage to the brain and lead to a stroke. The stent improves blood flow to the brain and lowers the risk of stroke.
Possible Complications
Problems are rare, but all procedures have some risk. Your doctor will review some problems that may happen, such as:
- Infection
- Allergic reactions to anesthesia or contrast dye
- Stroke due to a blood clot
- Bleeding
- Kidney damage
- Heart attack
- The artery becomes narrow again
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of problems, such as:
- Smoking
- Chronic disease such high blood pressure or kidney disease
What to Expect
Prior to Procedure
The doctor will review any tests that were already done. An ECG may be done if you haven’t had one recently.
Follow these steps leading up to the procedure:
- Arrange for a ride to and from the care center. Also, arrange for someone to help you at home.
- Talk to your doctor about your medicines. You may be asked to stop taking some up to one week before surgery.
- Tell your doctor about any allergies you may have, including any allergy to contrast dye.
- Tell your doctor if you may be pregnant.
- Do not eat or drink after midnight the night before surgery.
Anesthesia
You will have local anesthesia. It will numb an area in the groin.
Description of the Procedure
An incision will be made in your groin. A hollow needle will be inserted into a blood vessel in your groin. The doctor will pass a long tube along the needle, into the blood vessel, then to the neck area. An x-ray machine will show the doctor where the tube is in your body. The image will appear on a monitor in the room. A dye will be passed through the tube. It will highlight blood vessels to make them easier to see. It will also show where there may be problems with blood flow.
The doctor will find where the problem area is. A balloon may be passed through the tube. It is quickly opened and closed to push open the artery. The stent will then be passed through the tube. It will be put into place to hold the artery open. The doctor will be able to see if blood flow has improved. Once work is done, the tube will be slowly taken out. A bandage will be put on the incision.
Immediately After Procedure
You will need to lie flat for 2 to 6 hours.
How Long Will It Take?
It will take 1 to 2 hours.
How Much Will It Hurt?
Anesthesia will prevent pain during the procedure. You may have some discomfort when the tube is first inserted. The area will be sore for a few days after.
Average Hospital Stay
You may need to stay in the hospital overnight.
Post-procedure Care
At the Care Center
The staff will check on your progress until the anesthesia wears off. During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Wash their hands.
- Wear gloves or masks.
- Keep your incision covered.
There are also steps you can take to reduce your chances of infection such as:
- Wash your hands often. Remind visitors and healthcare team to do the same.
- Remind your healthcare team to wear gloves or masks when needed.
At Home
Strenuous activities will need to be limited for 2 weeks.
Call Your Doctor If Any of the Following Occurs
Call your doctor if any of these occur:
- Signs of infection, such as fever and chills
- Redness, swelling, pain, bleeding, or discharge from the incision
- Pain that you cannot control with the medicine you were given
- Pain, swelling, cramping, or loss of feeling in your legs
- Chest pain
- Lightheadedness
If you think you have an emergency, call for emergency medical services right away.
RESOURCES:
American Heart Association
http://www.heart.org
National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov
CANADIAN RESOURCES:
Health Canada
https://www.canada.ca
Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca
REFERENCES:
Brott TG, Halperin JL, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. Stroke. 2011 Aug;42(8):e420-63 full-text, correction can be found in Stroke 2011 Aug;42(8):e541.
Carotid angioplasty and stenting. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/carotid-angioplasty-and-stenting. Accessed July 19, 2020.
Carotid artery disease: carotid stenting. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/treatments/16850-carotid-artery-disease-carotid-stenting. Accessed July 19, 2020.
Carotid artery stenosis repair. EBSCO DynaMed website. Available at: https://www.dynamed.com/topics/dmp~AN~T116305/Carotid-artery-stenosis-repair. Accessed July 19, 2020.
Carotid artery stenting. British Society of Interventional Radiology website. Available at: https://www.bsir.org/patients/carotid-artery-stenting. Accessed July 19, 2020.
Carotid stenting. UCSF Department of Surgery website. Available at: https://surgery.ucsf.edu/conditions--procedures/carotid-stenting.aspx. Accessed July 19, 2020.
Endovascular angioplasty with stenting (CAS). Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/cerebrovascular/treatment/carotid_angioplasty_with_stenting.html. Accessed July 19, 2020.
Last reviewed July 2020 by EBSCO Medical Review Board Rimas Lukas, MD Last Updated: 7/19/2020