What is carotid artery stenting?

Carotid artery stenting is a procedure to open a narrowed carotid artery. There is a carotid artery on each side of the neck. They supply blood to the brain.

Fatty buildup can narrow these arteries. This buildup is called plaque. When one or both of your carotid arteries are narrowed, it can make it hard for blood to flow to the brain. This buildup also raises your risk of stroke. This procedure may improve blood flow to your brain and lower your risk of having a stroke.

You will get medicine to prevent pain and help you relax. The doctor will put a small tube into a blood vessel in your groin or arm. This tube is called a catheter. The doctor will move it through the blood vessel to your carotid artery. Then the doctor will put dye into the catheter. The dye will make your carotid artery show up on X-ray pictures. This lets the doctor find the narrow section of the artery.

The catheter is used to move a balloon and an expandable tube, called a stent, into the artery. The balloon is placed inside the stent and inflated. This opens the stent and pushes it into place against the artery wall. The balloon is then deflated. The doctor will take out the balloon and catheter from your body. The stent will stay in your artery. After time, the cells lining the blood vessel will grow through and around the stent to help hold it in place.

The procedure usually takes about 1 to 2 hours. You may need to stay in the hospital for 1 or 2 days after the procedure.

Activity

• If the doctor gave you a sedative:
  • For 24 hours, don't do anything that requires attention to detail, such as going to work, making important decisions, or signing any legal documents. It takes time for the medicine's effects to completely wear off.
  • For your safety, do not drive or operate any machinery that could be dangerous. Wait until the medicine wears off and you can think clearly and react easily.
• Do not do strenuous exercise and do not lift, pull, or push anything heavy until your doctor says it is okay. This may be for several days. You can walk around the house and do light activity, such as cooking.
• If the catheter was placed in your groin, try not to walk up stairs for the first couple of days.
• If the catheter was placed in your arm near your wrist, do not bend your wrist deeply for the first couple of days. Be careful using your hand to get into and out of a chair or bed.
• If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
• Ask your doctor when you can drive again.
• Your doctor will tell you when you can have sex again.
• Carry your stent identification card with you at all times.

Diet

• Drink plenty of fluids to help your body flush out the dye. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• Keep eating a heart-healthy diet that has lots of fruits, vegetables, and whole grains. If you need help with your diet, talk to your doctor. You also may want to talk to a dietitian. This expert can help you learn about healthy foods and plan meals.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Your doctor may prescribe a blood thinner such as aspirin. It is important that you take these medicines exactly as directed to help reduce your risk of a stroke. Be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.

Care of the catheter site

• For 1 day or for as long as your doctor recommends, keep a bandage over the spot where the doctor put in the catheter.
• Put ice or a cold pack on the area for 10 to 20 minutes at a time to help with soreness or swelling. Put a thin cloth between the ice and your skin.
• You may shower 24 to 48 hours after the procedure, if your doctor okays it. Pat the incision dry.
• Do not soak the catheter site until it is healed. Don't take a bath for 1 week, or until your doctor tells you it is okay.
• Watch for bleeding from the site. A small amount of blood (up to the size of a quarter) on the bandage can be normal.
• If you are bleeding, lie down and press on the area for 15 minutes to try to make it stop. If the bleeding does not stop, call your doctor or seek immediate medical care.

If you have not had a TIA or stroke

For people who have not had a stroke or TIA, it is not clear when stenting might be a good choice. 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 a heart-healthy lifestyle 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 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 a heart-healthy lifestyle. 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.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

The risks of carotid artery stenting include:

• Infection.
• Bleeding at the catheter insertion site.
• Damage to the blood vessel at the catheter insertion site.
• Stroke, heart attack, or death.
• The artery can narrow again.

The risks of a procedure depend on things like your age and your overall health.

You may need to stay in the hospital for 1 or 2 days after the procedure.

After you leave the hospital, you may notice a bruise or small lump where the catheter was put in. This is normal and will go away. The area may feel sore for a few days. You can do light activities around the house. But don't do anything strenuous until your doctor says it's okay. This may be for at least several days.

You will take medicines to help prevent a stroke. You will still need to have a heart-healthy lifestyle. This lifestyle includes eating healthy foods, being active, staying at a healthy weight, and not smoking. This will give you the best chance for a longer, healthier life.

You will have regular tests to check blood flow in your carotid arteries.

Carotid artery stenting is done to help lower your risk of stroke.

Your doctor may recommend this procedure based on certain things. These include:

• The amount of narrowing (stenosis) in your carotid arteries. A procedure may be an option if the narrowing is 50% or more.
• Whether you had a stroke or TIA within the past 6 months. If you have not had a stroke or TIA, it is less clear that the procedure will help you.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
• The procedure takes about 1 to 2 hours.
• After the procedure, pressure may be applied to the area where the catheter was put in your blood vessel. This will help prevent bleeding. A small device may also be used to close the blood vessel. The area may be covered with a bandage or a compression device.
• Nurses will check your heart rate and blood pressure. The nurse will also check the catheter site for bleeding.
• You will need to lie still and keep your leg straight for up to a few hours. The nurse may put a weighted bag on your leg to keep it still.
• If the catheter was put in your arm, you may be able to sit up right away. But you may need to keep your arm still for at least 2 hours.
• You may have a bruise or a small lump where the catheter was put in your blood vessel. This is normal and will go away.