Carotid stenting

Carotid Stenting is a minimally invasive surgical procedure aimed at treating carotid artery disease, a condition characterized by the narrowing or blockage of the carotid artery, which is a major blood vessel supplying blood to the brain. This procedure is crucial in preventing stroke, as the narrowing of the carotid arteries increases the risk of stroke by reducing blood flow to the brain and potentially causing blood clots.

Indications

Carotid stenting is typically recommended for patients who are considered high-risk for carotid endarterectomy, which is a more invasive surgical procedure to remove plaque from the carotid artery. Indications for carotid stenting include:

• Significant stenosis (narrowing) of the carotid artery, usually more than 70%, as confirmed by ultrasound, CT angiography, or magnetic resonance angiography (MRA).
• Symptoms of carotid artery disease, such as transient ischemic attacks (TIA) or minor strokes.
• Patients with medical conditions that make traditional surgery too risky, such as heart disease, lung disease, or previous neck surgeries.

Procedure

The carotid stenting procedure involves the following steps:

1. A catheter is inserted into a blood vessel, typically through the groin, and guided to the carotid artery using X-ray imaging.
2. A balloon catheter is then advanced to the site of the narrowing and inflated to open the artery.
3. A stent, which is a small, metal mesh tube, is placed at the site of the narrowing to keep the artery open.
4. The balloon is deflated and removed, leaving the stent in place permanently to support the artery walls and improve blood flow.

Risks and Complications

While carotid stenting is less invasive than carotid endarterectomy, it carries its own risks and complications, including:

• Stroke or mini-stroke (TIA) during or after the procedure.
• Blood clots forming within the stent.
• Re-narrowing of the artery (restenosis) over time.
• Blood vessel damage at the site of the catheter insertion.
• Allergic reaction to the contrast dye used during the procedure.

Recovery

Recovery from carotid stenting is generally quicker than from carotid endarterectomy. Patients may be required to stay in the hospital overnight for monitoring and can usually return to normal activities within a week. Medications such as antiplatelet drugs may be prescribed to prevent blood clots around the stent.

Outcomes

Carotid stenting has been shown to effectively reduce the risk of stroke in patients with significant carotid artery narrowing, especially in those who are high-risk for surgical treatment. However, the long-term effectiveness and comparison with carotid endarterectomy in various patient populations continue to be studied.

See Also

• Stroke prevention
• Carotid endarterectomy
• Transient ischemic attack
• Atherosclerosis