Carotid stenting is a fairly new, catheter-based procedure in which a small, expandable wire mesh tube (stent) is inserted into a diseased artery to serve as a scaffold and hold it open. This treatment provides an effective means of re-establishing blood flow through blocked carotid arteries.
Carotid artery stenting is performed in patients with carotid artery disease - a type of peripheral artery disease in which there is "artery hardening" (atherosclerosis) in the main arteries carrying oxygen-rich blood to the brain (the carotid arteries). People with carotid artery disease are at much higher risk of having an ischemic stroke, the most common type of stroke. Treatment options have historically included a combination of medications, lifestyle changes and a surgery known as carotid endarterectomy (CEA). In this operation, vascular surgeons make a small incision in the neck and remove the plaque responsible for the blockage. Many patients with carotid artery disease, however, have coexisting conditions such as heart disease that make them poor candidates for surgery. For these patients, as well as for those who are symptomatic or who have a carotid blockage of 80 percent or more, using a stent offers a less invasive approach to treating their disease.
Though the Food and Drug Administration (FDA) just recently approved the first stent for use in treating carotid artery blockages, stents have been used widely to treat blockages in other vessels of the body. Results from a recent study known as SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy), published in the New England Journal of Medicine last October, indicate that carotid stenting is as effective as traditional surgery at opening plaque-filled carotid arteries in patients at high risk for open surgery.
A team including both an interventional cardiologist and an interventional neuroradiologist will perform the procedure together. You will be given a mild sedative through an IV in your arm. You should feel drowsy and relaxed, while remaining alert enough to follow instructions and describe sensations. Devices that monitor your heart rate and blood pressure will be attached to your body. Your groin will be shaved and numbed with a local anesthetic, and then a small nick will be made in the skin for the interventional neuroradiologist to insert a balloon-tipped catheter (thin plastic tube). The radiologist will use high-resolution X-ray equipment to carefully guide the catheter to the site of the blockage, where the balloon is then inflated to open the artery. When stenting is performed at the same time as balloon angioplasty, a small wire mesh tube (stent) is placed over the balloon-tipped catheter and then pushed against the artery wall, where it helps the artery heal in an open position. Unlike the balloon, the stent is not removed but remains in the artery after the procedure, to act as a permanent scaffolding to help keep the artery open. Drug-coated stents are also available and contain medication that is slowly released to keep the blood vessel from renarrowing. Following the procedure, your heart rate, blood pressure and groin puncture site are checked frequently in an observation unit. Typically, you will be monitored overnight, and if indicators are favorable, you will be discharged the next day. You will need to return for a follow-up clinic visit three weeks later, as well as for an ultrasound three months following the stenting procedure, to make sure the treated artery remains open and blood flow through the area is sufficient. Your Lahey health care team will answer all of your questions and talk to you in more detail about what to expect before, during and after your procedure.