Similar to the coronary arteries of the heart, carotid arteries in the neck can also develop atherosclerotic plaques. The accumulation of fatty deposits and cholesterol on the inner side of the arteries is called atherosclerotic plaque. Over time, this buildup narrows the artery, reduces blood flow to the brain, and can lead to a stroke.
During a carotid artery stent procedure, under X-ray guidance, the location of the blockage or stenosis (narrowing due to plaque) in the carotid arteries is identified, and interventional treatment is performed by widening the artery using a balloon and placing a stent to maintain an open passage and blood flow in the artery.
Carotid artery stenting can be performed when there is suspicion of carotid artery disease, based on test results such as Duplex ultrasound, computed tomography (CT), and magnetic resonance angiography (MRA). The procedure is usually done in patients who experience symptoms or have a 70% or greater blockage in the artery and for whom surgery would be highly risky.
This approach is less invasive than traditional carotid artery surgery, which is the standard treatment for blockages in this artery. Carotid artery stenting can be performed with local anesthesia while the patient is awake, and the recovery time is shorter.
In the first stage, a catheter (a thin and hollow tube) is inserted into the blood vessel in the leg (femoral approach) or arm (radial approach). The catheter is advanced through the arteries to the carotid artery with the help of a specialized X-ray machine. Contrast material is injected through the catheter, and X-ray images are taken as the contrast material passes through the arteries. The digital images help identify the site of the blockage or stenosis.
Then, a metal wire is guided through the catheter beyond the site of the blockage in the artery. Over the wire, a small balloon is positioned at the location of the stenosis. When inflated, the balloon pushes the atherosclerotic plaque against the walls of the artery, and the diameter of the blood vessel increases. The balloon is deflated, and a stent made of a metal mesh is placed inside the artery to support the arterial wall and maintain its expanded diameter.
After the stent is placed, additional contrast material is injected to ensure that the stent has fully expanded and the blockage or stenosis has been corrected. Often, the balloon is reinflated inside the stent to ensure it opens to its maximal diameter. The stent remains in place and serves as a scaffold to support the artery. Over the next few weeks, the artery heals around the stent.
During the carotid artery stenting procedure, medications such as heparin are given to reduce the risk of blood clots. Additionally, aspirin or Plavix may be prescribed for three to five days before the procedure and for four to six weeks after the stenting to further reduce the risk of blood clots.