What is carotid stenting?

A small metal tubular structure called a stent is inserted into the carotid artery that supplies essential blood flow to the brain. The stent acts as scaffolding, keeping the artery stretched open and maintaining adequate blood flow through the vessel after it is opened with a balloon. Debris that might otherwise enter the circulation to the brain at the time the carotid artery obstruction is dilated is removed by a removal device prior to stenting to help prevent the debris from causing a stroke.

When does a patient’s condition require carotid artery stenting?

When plaque build-up (atherosclerosis) causes enough narrowing or blockage of a carotid artery so that blood supply to part of the brain is reduced or such that blood clots may begin to form, the risk of stroke becomes very high. Symptoms accompanying this condition often include transient ischemic attacks (TIA or mini-stroke), or full-blown stroke with damage to the brain. Even with no symptoms or history of stroke, very severe blockages in a carotid artery should be opened or treated with surgery in order to prevent strokes that may otherwise occur.

What tests can determine a need for carotidstenting?

During regular physical exams your physician often examines your carotid arteries by listening to them with a stethoscope.  Narrowing in a carotid artery often causes an audible noise, or bruit, due to increased velocity of blood flow through the area of obstruction.  Diagnostic tests may be ordered to confirm the presence of atherosclerosis with narrowing or obstruction in patients with a bruit or in patients with symptoms suggestive of TIA or stroke.

A carotidultrasound (sonogram of the carotid arteries) uses sound waves to evaluate the structure and function of the carotid arteries. It provides a moving image of the arterial blood flow, allowing your cardiologist to study the carotid arteries’ diameters and the blood flow through them.

Computed tomography angiography (CTA) is a type of CAT scan that uses x-ray beams taken from different angles around the patient to create pictures of cross-sections of the body. Contrast medium is injected into the veins at the time of the CT scan so that the arteries will also be visualized. Using computerized techniques, the scanner can be programmed to show pictures of only the arteries, which is a CTangiogram.

A carotidangiogram, or arteriogram is an invasive procedure involving insertion of a catheter, usually through a leg artery, up to the carotid vessel(s) of the neck, where contrast medium is injected and X-rays pictures are taken to show the inside of the carotid vessels. A carotid angiogram is one of the most accurate tests in the diagnosis of carotid artery disease, and is used to pinpoint the location and severity of plaque build up and blockage.

How is carotid artery stenting performed?

Carotid stenting is a catheter-based procedure. The catheter acts as a guide to place the stent in the carotid artery to open a narrowing or blockage.  The stent is deployed at the time the blockage in the artery is dilated with a balloon.  Stents come in a variety of strengths, sizes, and other properties. Stent selection for each procedure depends upon many factors, including the size of the artery, the location of the plaque build-up or blockage, and the severity of arterial narrowing.

What should be expected after carotid artery stenting?

Carotid stents are exposed to blood flow and may cause clots to form until they become covered with tissue by the body. Medications are taken during this time, and possibly longer, to prevent thrombosis (formation of blood clots). Check your anticoagulant therapy section in this brochure to determine what medication your cardiologist has prescribed.

Sometimes new blockages develop months or years later at a different site in a carotid vessel.  Rarely, carotid stents re-narrow (restenosis). Because of the possibility of restenosis and / or new blockages, your cardiologist will want you to follow-up with a diagnostic testing schedule. Adhere to your testing and follow-up schedules below. Call your cardiologist’s office to schedule any tests that are not prescheduled. Follow-up is vital to early detection of re-narrowing or new disease of the carotid arteries.

The usual recommendation for carotid stent follow up is an ultrasound study at:

• Six weeks
• Six months
• One year
• Then Annually

All testing schedules are subject to change according to each individual patient’s condition, risk factors, or recurrence of carotid artery disease signs and symptoms.