Carotid Artery Stenting

The carotid artery narrowing can be diagnosed using ultrasound, CT angiography, magnetic resonance angiography, or cerebral angiography to determine the presence and location of the stenosis. Treatment to improve or restore blood flow may include vascular stenting or open surgery.

Carotid Artery Stenting procedure

The procedure is performed by an experienced Neurointerventional Radiologist, in the angiography suite of the hospital.

To reduce the likelihood of blood clots forming on the stent, you will be required to take medication to thin the blood (aspirin plus clopidogrel or ticagrelor), typically commencing five days before the procedure.

A liquid dye (contrast medium) is injected to outline the arteries so they are visible with x-ray fluoroscopy using specialised medical imaging equipment.

The specialised x-ray machine is used to take pictures as a catheter is guided from the groin or wrist artery, to the target carotid artery.

Frequently, a device to reduce the risk of the procedure (embolic protection device) will be inserted over a wire to catch any tiny blood clots or particles of material blocking the artery that might break away during the procedure.

A small mesh tube, called a stent is placed across the diseased narrowing, expanding it and holding it open. The embolic protection device and all catheters will be removed at the end of the procedure.

Usually a closure device is used to quickly seal the small cut where the original catheter was inserted in the groin.

The procedure usually takes up to two hours.

Referral

Your general practitioner, vascular surgeon or neurologist can refer you for this procedure if they feel this is suitable for you.

Preparation

The procedure will be performed under sedation or general anaesthesia administered by an anaesthetist.

You will be instructed to fast for 6 hours prior to the procedure, this means nothing to eat or drink. However, you may take your usual medications with sips of water.

You will need someone to drive you home after the procedure.

What to expect after the procedure

Immediately after the procedure you will need to remain in bed for two hours, to ensure the groin access site has stopped bleeding. After this, you will be encouraged to mobilise as tolerated.

After the procedure, you will be transferred to the recovery ward before being transferred to the intensive care or high dependency ward and stay overnight. The intensive care staff will monitor closely, ensuring blood pressure is well controlled.

The next day, most patients will be transferred to the ward.

You may need to stay in hospital for 1 – 3 days.

The stronger blood thinning tablets (clopidogrel or ticagrelor) will need to be taken for six months and aspirin must be continued lifelong.

An imaging procedure, usually CT angiography, will be arranged three months after having the carotid stent to check whether the artery has narrowed again.

Risks and Side Effects

CAS is less invasive than surgery. However, like any medical procedure, is associated with some risks, including bruising and bleeding at the groin artery site, damage to the groin artery or, you may have an allergic reaction to the contrast material.

The major risk is stroke during the stenting procedure and may occur in 2-7% of patients, and is similar to surgery (carotid endarterectomy). Doctors may recommend CAS when they believe patients are less likely to be at risk than if they had open surgery.

Occasionally, the artery that has been stented narrows again. This will be checked at the follow up imaging. If this occurs, the procedure can be repeated, and the area can be re-stretched with a special vascular balloon.