Carotid angioplasty and stenting are procedures that open clogged arteries to restore blood flow to the brain. They're often performed to treat or prevent strokes. Your carotid arteries are located on each side of your neck that mainly supply blood to your brain. They can be clogged with fatty deposits (plaque) that slow or block blood flow to the brain which can lead to a stroke. The procedure involves temporarily inserting and inflating a tiny balloon into the clogged artery to widen the area so that blood can flow freely to your brain. A carotid angioplasty is usually combined with another procedure called stenting. Stenting involves placing a small metal coil in the clogged artery that helps prop the artery open and decreases the chance of it narrowing again. Carotid angioplasty and stenting may be used when traditional carotid surgery (carotid endarterectomy) isn't possible, or it's too risky.
Carotid Angioplasty is normally used in stroke treatment or stroke prevention in the following cases: -A carotid artery has a significant amount of blockage -The patient has had a stroke or a transient ischemic attack (also called a TIA) -The patient has had a recurrence of blockage in the same artery -The patient is not physically capable for surgery -The blockage is difficult to reach with other procedures or surgery
$10,000 to $20,000
-Can reduce the risk of stroke
-Restenosis can occur. Scar tissue may grow in the treated area of the artery. This can cause it to become narrow or blocked again. Sometimes this happens within a matter of months.
-Risk of blood clot forming within the stent. To reduce the risk, doctors often prescribe aspirin plus another anticlotting medicine. Although these medicines are very helpful, there is always a chance of unwanted side effects, such as an allergic rash or excessive bleeding.
An IV will be put in your arm or hand before the procedure starts. You’ll be given sedation through the IV line. This will make you relaxed and sleepy during procedure. The doctor will first make a small incision in a blood vessel in your groin followed by the insertion a long, thin wire into this cut. The wire acts as a guide for during the procedure. The doctor will then insert a thin, flexible tube (catheter) over the wire. It has a tiny deflated balloon on the end. The catheter will be threaded through the blood vessel all the way into the carotid artery in your neck. Continuous X-ray images may be used to show exactly where the catheter is. The balloon will be inflated inside the narrow part of the carotid artery and stretch the area open. The stent may be left in place in the area and help keep the area open. The balloon will be deflated, and the catheter will be removed. The incision site in the groin will be closed and bandaged. The procedure usually takes around 1-2 hours.
Before a scheduled angioplasty, your doctor reviews your medical history and performs a physical exam. You may also have one or more of the following examinations: -Ultrasound. A scanner passes over the carotid artery to produce images using sound waves of the narrowed artery and of the blood flow to the brain. -Magnetic resonance angiography (MRA) or computerized tomography angiography (CTA). These exams provide highly detailed images of blood vessels by using either radiofrequency waves in a magnetic field or by using X-rays with contrast material. -Carotid angiography. During this exam, contrast material (visible on X-rays) is injected into an artery to better see and examine the blood vessels.
To avoid bleeding from the catheter insertion site, you need to lie relatively still for several hours. You'll be either in the recovery area or in your hospital room. After the procedure, you may receive an ultrasound of your carotid artery. Most people are discharged from the hospital within 24 hours after the procedure. The catheter site may remain tender, swollen and bruised for a few days. There may be a small area of discoloration or a small lump in the area of the puncture. You may take acetaminophen (Tylenol, others) in the recommended dose as needed for discomfort, or other medication as prescribed by your doctor. You may need to avoid strenuous activity and heavy lifting for 24 hours after the procedure.
As with any surgery, there are risks, including the possibility of: -Complications associated with anesthesia -Bleeding in the catheter access location -Stroke / stroke recurrence -Allergic reaction to chemicals used in the procedure or investigative procedures -Infection Often, the stroke is related to some facet of the patient’s lifestyle or some form of co-morbidity, such as hypertension or diabetes. The carotid angioplasty attempts to correct the symptoms of the condition which brought about the blockage, but does nothing to deal with the underlying reason why the blockage started in the first place. Because of this, without changes in the patient’s lifestyle or treatment of the co-morbid factor, the blockage is likely to happen again.
How well do carotid angiolasties work?
This will depend on your history and whether you have had previous history of stroke or transient ischemic attack or not. If you have not had a TIA or stroke: Stenting may help prevent a stroke in the long run. But in the short run, it increases the risk of stroke and death. Medicine and lifestyle changes may work as well as stenting to prevent a stroke, and they don't have the risks of stenting. Carotid artery stenting may be an option if you have more than 60% to 70% narrowing and you have a low risk of serious problems from stenting. It is not clear that stenting will reduce your stroke risk more than medicines and lifestyle changes alone. Studies are being done to compare current medical therapy with stenting. If you have had a TIA or stroke: Carotid artery stenting can help lower your risk of stroke if your carotid artery is narrowed by 50% or more. You may benefit most from stenting if it is done within 2 weeks of the stroke or TIA. This is when the risk of stroke is highest.
What does long term recovery look like after the procedure?
Your recovery from the actual carotid angioplasty and stenting procedure will typically be brief, but it is only the beginning of the process of preventing a future stroke, heart attack or other forms of cardiovascular disease. Lifestyle changes and taking medications exactly as prescribed by your physician can help slow, halt or reverse the underlying disease process that caused blockages in your carotid arteries and that affects all arteries throughout your body.