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Endovascular Therapy

Unilateral Carotid Stent

Unilateral carotid stenting is a surgical procedure in which your surgeon inserts metal-mesh tubing called a stent inside your carotid artery to increase blood flow in areas blocked by plaque.

Because of hardening of the arteries, plaque builds up in the walls of your arteries as you age. As plaque increases, your arteries will narrow and stiffen. Eventually, enough plaque may build up to reduce blood flow through your arteries, or cause blood clots or pieces of the plaque to break away and block the arteries in the brain beyond the plaque.

You have carotid arteries located on each side of your neck and they extend from the aorta in your chest to the base of your skull. These arteries supply blood to your brain. You have one main carotid artery on each side, and each of these divides into two major branches, the external and the internal.

When plaque accumulates and reduces blood flow in your carotid arteries, you have carotid artery disease. This can create a serious issue because clots can attach to the plaque and block the blood flow to your brain. If blood flow is blocked to your brain the result is an ischemic stroke, which can cause brain damage or death. Another related problem that the plaque can cause is an arterial embolism; this is when a small piece of plaque or a blood clot breaks becomes loosened and blocks another artery downstream. If the clot blocks a tiny artery in the brain, the result can be a transient ischemic attack a mini-stroke.

When your physician wants to treat a blocked carotid artery, he or she may recommend that you have a stent inserted as an alternative to surgical removal of the plaque, known as unilateral carotid stent. During this procedure, your surgeon places a stent into your carotid artery after performing angioplasty. The stent holds the artery open by holding back the flattened plaque like scaffolding.

The Procedure

Before placing a stent, your surgeon will likely perform an angioplasty. In an angioplasty, your surgeon inserts a thin tube called a catheter with an attached balloon into a small incision over an artery in your arm or groin. Your surgeon guides the catheter to the blockage site in your carotid artery using live x-ray imaging. You will not feel the catheters as they move through your arteries because there are no nerve endings inside your arteries.

Your surgeon may insert a small balloon, basket, or filter called an embolic protection device. This device helps to prevent strokes by catching the clots or debris that may break away from the plaque during the procedure. At the blockage site, the surgeon inflates and deflates the angioplasty balloon to flatten the plaque and widen the space where the blood flows through. After the artery is open, your surgeon will remove the catheter with the balloon attached. Using a different catheter, your surgeon moves a compressed stent to the same area in your carotid artery. Once the stent has been placed, your surgeon will release it. The stent then expands to fit the artery. It is possible that your surgeon will then uses a balloon catheter to further expand the stent.

After your surgery

Immediately after the procedure, pressure is applied to the catheter insertion site in the groin or arm for 15 to 30 minutes to allow it to close and prevent bleeding. If your surgeon inserts the catheters and other instruments through your femoral artery, your physician may instruct you to stay in bed for the next several hours so that you can be monitored for any complications, such as excessive bleeding from the puncture site.

You may be instructed not to lift anything more than about 5 to 10 pounds after you return home to avoid any pressure on the incision. Your surgeon may also instruct you to only shower for a few days and to drink plenty of water to help remove the dye from your system. You will take blood thinning medications and be scheduled for periodic follow-up examinations, typically including carotid ultrasound examinations, to ensure your stent is functioning well.

Risks

Blockage by a clot or other debris in an artery in your brain, called an embolism, is a very serious complication that can occur after carotid stenting since this blockage can cause a stroke. Other risks that can cause a stroke include a blood clot forming along the stent or damage to the artery wall which is called a dissection. Re-blockage of the carotid artery, called restenosis, is also possible. The dye used in an angiogram has been known to cause damage to the kidneys, especially for those already experiencing kidney troubles. Bleeding at the incision site in the groin or arm artery, called a hematoma or a false aneurysm, can also occur, but this is unusual. Bruising and tenderness at the incision site is common and usually diminishes with time.