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Carotid Angioplasty and Stenting

Overview

carotid-anatomy(copy)(copy)

The carotid arteries are located on each side of your neck and supply blood to your brain. Carotid artery disease is the term used to describe narrowing of these arteries due to the build-up of atherosclerotic plaque (deposits of fatty and fibrous tissue on the inside of the arteries).  Fragments of plaque, or blood clot that forms over the plaque, may break off and be carried by the blood flow into the brain, where they can block arteries, causing a stroke. About 15% of all strokes are due to carotid artery disease. Carotid angioplasty and stenting is a minimally invasive procedure that opens narrowed arteries to prevent a stroke. 











 

What is Carotid Angioplasty and Stenting?

Carotid angioplasty is a non-surgical procedure performed after non-invasive imaging (ultrasound, CT scanning or MR scanning) has demonstrated a significant narrowing that is amenable to treatment by the implantation of a stent.  

Carotid artery angioplasty and stenting is performed through a tube (catheter) that is usually inserted in an artery in the groin, although it may sometimes be peformed via an artery in the arm or wrist. A balloon catheter is guided to the area of the blockage or narrowing after a guide wire with an integrated filter has been placed beyond the narrowing (the filter is to catch any debris released during the procedure and prevent it reaching the brain).  The balloon is inflated to stretch open the narrowed artery and allow passage of a small wire mesh tube (called a stent). The stent helps prop the artery open and decreases the chance of it renarrowing. 
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Why do I need Carotid Angioplasty and Stenting?

Carotid angioplasty and stenting may be an appropriate stroke prevention option if:
  • You have a history of heart problems, such as congestive heart failure, unstable angina or a failed stress test.
  • You have a carotid artery with a 80 percent blockage or more, especially if you have already had a small stroke or stroke symptoms, and you are not in good enough health to undergo surgery.
  • You have already had a carotid endarterectomy and are experiencing new narrowing after surgery (restenosis).
  • The location of the narrowing (stenosis) is difficult to access with endarterectomy.
 
In some cases, traditional carotid surgery (carotid endarterectomy) may be advised to remove the buildup of plaque (fatty material) and treat the narrowing. In other cases, angioplasty and stenting may be a better option. 
 
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How is Carotid Angioplasty and Stenting performed?

The procedure will be conducted in an angiography suite (“cath lab”) at Mercy Angiography, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your specialist will be assisted by nurses and other highly trained staff.
 
  • You will be awake during the procedure but lightly sedated.  Your groin will be numbed with local anaesthetic before the catheter is introduced.  You should not feel pain at the entry site but there may still be some non-painful sensations such as pressure.
  • A small tube (sheath) is placed into the artery. A catheter is then threaded through the tube to the narrowing in the carotid artery under X-ray guidance. You don’t feel the catheter passing through the arteries because the insides of arteries don't have nerve endings.
  • Contrast material is injected into the carotid artery through the catheter. The contrast material may cause a temporary warm feeling on one side of your face. Contrast material provides a detailed view of the narrowed artery and blood flow to the brain.
  • Because of the potential for clots to dislodge from the plaque into the circulation of the brain and possibly cause a stroke, an umbrella-shaped filter is attached to the guide wire. The filter (embolic protection device) is inserted beyond the narrowing to catch any clots or small debris that may break off from the narrowed area of artery during the procedure.
  • A balloon is inserted into the narrowed area and inflated to widen the vessel in preparation for stent implantation.
  • A small metal mesh tube (stent) is then placed in the vessel. The expanded stent serves as a scaffold that helps prevent the artery from narrowing again.
  • Following this, the filter, sheath and catheter are removed. Pressure is applied to the catheter insertion site to prevent bleeding.
Carotid Cine Images
 
 
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What will I experience during the procedure?

  • An intravenous catheter (IV line) for administration of fluids and medication will be inserted into a vein on the back of your hand or in your arm.
  • You will feel a slight prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anaesthetic is injected through your groin.
  • You will be given mild sedation through your IV to make you feel relaxed.
  • You may feel slight pressure when the catheter is inserted but no serious discomfort.
  • As the contrast material passes through your body you may get a warm feeling on one side of your face.
  • While you are in hospital your pain will be well controlled with medication infused through your IV line.
 
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How should I prepare for my procedure?

  • Fasting: You will likely be instructed not to eat or drink anything after midnight before your procedure.  Your doctor will tell you which medications to take in the morning.
  • Medications: Please inform your doctor of all the medications you are taking. Your doctor may advise you to stop taking some medications temporarily a few days prior to the procedure.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform Mercy Angiography staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are diabetic you should inform your doctor at the time of booking. You may need to discuss your insulin dose with your specialist.
On the day of your procedure, please make your way to the Mercy Hospital Reception where they will be expecting you. You will be admitted to a hospital ward and brought down to Mercy Angiography for your procedure at the appropriate time.

For directions to the Mercy Hospital, click here.
 
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What happens after the procedure?

  • When the procedure is done, you will lie still in one position while pressure is applied to the site to stop bleeding. You will then be taken to the recovery area.
  • To avoid bleeding from the catheter insertion site, you need to lie relatively still for several hours, either in the recovery area or in your hospital room.. Most people are discharged from the hospital the day 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 need to avoid strenuous activity and lifting for a minimum of 24 hours after the procedure.
 
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What are the risks?

Your doctor will discuss the specific risks and potential benefits of the procedure with you. The risks vary, depending on the severity of your disease, location of the blockage, whether you have had a previous stroke and the presence of other medical conditions.
 
Some of the possible risks include:
  • Bleeding at the catheter insertion site
  • Allergic reaction to the x-ray contrast (dye)
  • Heart attack, stroke or death
 
There may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand why the procedure is recommended and what the potential risks are. 
 
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