What is carotid artery stenting?
Carotid artery stenting (CAS) is performed through catheter techniques, requiring only a small incision in the groin. A special catheter inserted into the carotid artery has a tiny balloon at its tip that is inflated once the catheter has been placed into the narrowed area. This compresses the fatty tissue in the artery and makes a larger opening for improved blood flow. A tiny, expandable metal coil called a stent may be inserted into the newly-opened area to help keep the artery from narrowing or closing again.
Why is carotid artery stenting performed?
If you are at high-risk for surgery, your doctor may suggest CAS. While this procedure is performed widely, the long-term effects are still being studied. High risk conditions under which CAS may be considered include, but are not limited to:
Coronary artery disease or pending open heart surgery
Heart failure, heart valve disease or heart arrhythmias
Angina or heart attack within the last six months
How to Prepare
Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will need to fast prior to the procedure. Your doctor will notify you how long to fast, usually overnight.
Notify your doctor of all medications (prescription, over-the-counter or herbal supplements) you are taking; if you are pregnant or suspect that you may be pregnant; if you are allergic to or sensitive to medications, local anesthesia, or latex; if you have kidney failure or other kidney problems or if you are allergic to or sensitive to contrast dye or iodine.
Your doctor may request a blood test to determine how long it takes your blood to clot.
What to Expect
You will be positioned on the table, lying on your back, and under local anesthesia, a small incision will be made in your groin are to insert the catheter. The catheter will be advanced up towards the heart and the carotid arteries and once in place, dye will be injected through the catheter in order to see the narrowed area(s) and x-ray pictures will be taken.
Once the cateter is in place, a balloon will be inflated to push back the blockage and place a stent in the opened area. When the procedure is completed you will be moved to recovery and then admitted overnight for observation and to manage any pain associated with the procedure.
What are the risks?
Because of the potential for clots (emboli) to dislodge from the plaque into the circulation of the brain and possibly cause a stroke, there are now devices called embolic protection devices (EPD) being used during CAS that "catch" any clots or small debris that might break loose. This technique may help reduce the incidence of stroke during carotid stenting.