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Carotid Angioplasty & Stenting

Like the blood vessels of the heart (coronary arteries), the carotid arteries which are located on each side of the neck and supplies blood to the brain also develop atherosclerosis, the build-up of fat and cholesterol deposits, called plaque, on the inside of the arteries. Over time, the build-up narrows the artery, decreases blood flow to the brain and can lead to a stroke.
Carotid Angioplasty involves temporarily inserting and inflating a tiny balloon into the clogged artery to widen the area so that blood can flow freely to your brain.
Carotid angioplasty is often combined with another procedure called stenting. Stenting involves placing a small metal coil (stent) in the clogged artery. The stent helps prop the artery open and decreases the chance of it narrowing again. Carotid angioplasty and stenting may be used when traditional carotid surgery (carotid endarterectomy) isn't possible, or it's too risky.

Why it's done?

Carotid angioplasty and stenting may be appropriate stroke treatments or stroke-prevention options if:

  • You have a carotid artery with a blockage of 70 percent or more, especially if you've had a stroke or stroke symptoms, and you aren't in good enough health to undergo surgery — for example, if you have severe heart or lung disease or had radiation for neck tumors
  • The location of the narrowing (stenosis) is difficult to access with endarterectomy
  • In some cases, carotid endarterectomy may be a better choice than angioplasty and stenting to remove the buildup of fatty deposits (plaque) clogging the artery

  • Risks

    With any medical procedure, complications might happen. Here are some of the possible complications of carotid angioplasty and stenting:

  • Stroke or ministroke (transient ischemic attack, or TIA): During angioplasty, blood clots that may form on the catheters can break loose and travel to your brain. You'll receive blood thinners during the procedure to reduce this risk.
  • A stroke can also occur if plaque in your artery is dislodged when the catheters are being threaded through the blood vessels.
  • New narrowing of the carotid artery (restenosis): A major drawback of carotid angioplasty is the chance that your artery will narrow again within months of the procedure. Special drug-coated stents have been developed to reduce the risk of restenosis.
  • Blood clots: Blood clots can form within stents even weeks or months after angioplasty. These clots may cause a stroke or death.
  • Bleeding: You may have bleeding at the site in your groin where catheters were inserted. Usually this simply results in a bruise, but sometimes serious bleeding occurs and may require a blood transfusion or surgical procedures.

  • Food and medications

    You'll receive instructions on what you can or can't eat or drink before angioplasty. Your preparation may be different if you're already staying at the hospital before your procedure.
    The night before your procedure:

  • Follow your doctor's instructions about adjusting your current medications. Your doctor may instruct you to stop taking certain medications before angioplasty, particularly if you take certain diabetes medications or blood thinners.

  • What you can expect?

  • Carotid angioplasty is considered a nonsurgical procedure because it's less invasive than surgery. Your body isn't cut open except for a very small nick in a blood vessel in your groin.
  • General anesthesia isn't needed, so you're awake during the procedure. You'll receive fluids and medications through an IV catheter to help you relax.
  • Before the procedure, you're taken to an X-ray imaging room and asked to lie on a procedure bed. You'll rest your head in a cup-shaped area to help you remain comfortable and still while pictures of the carotid artery are taken.
  • Your groin is shaved and prepared with antiseptic solution, and a sterile drape is placed over your body.
  • A local anesthetic is injected into your groin to numb the area.
  • Small electrode pads are placed on your chest to monitor your heart rate and rhythm during the procedure.

  • What happens during the carotid angiography procedure?

  • A medication such as heparin may be given during the procedure to reduce the risk of blood clots. You also may need to take aspirin and clopidogrel bisulfate for three to five days before the procedure and for four to six weeks after the procedure. Your doctor or nurse will give you specific instructions about what you can and cannot eat or drink prior to the procedure.
  • First, the doctor anesthetizes or numbs the area where the introducer sheath will be inserted. The sheath is a thin, hollow tube that is inserted into a blood vessel in the leg (femoral approach) or arm (brachial approach).
  • A long, narrow tube called a catheter is inserted through the sheath, and is guided through the aorta to the carotid artery with the aid of a special X-ray machine.
  • Some patients may have a second sheath placed in the leg or arm vein where a temporary pacemaker wire is placed in the heart to regulate the heart rhythm during the procedure.
  • Contrast material is injected through the catheter and X-ray movies are created as the contrast material moves through the carotid arteries (vessels that provide circulation to your brain). The digital photographs of the contrast material are used to identify the site of the narrowing or blockage.
  • If the diagnostic tests show severe narrowing or a blockage in the carotid artery, the carotid angioplasty and stenting procedure may be performed to open the artery, or surgery may be recommended.

  • What happens during the carotid angioplasty and stenting procedure?

  • A specially designed guide wire with a filter is placed beyond the site of the narrowing or blockage in the carotid artery. Once the filter is in place, a small balloon catheter is guided to the area of the blockage. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow. The balloon is removed and the stent is placed inside the artery to widen the opening and support the artery wall.
  • After the stent is placed, an angiogram is performed to confirm that the stent has completely expanded and the narrowing or blockage has been corrected. Often, a second balloon catheter is inflated to ensure the stent is maximally opened. The stent stays in place permanently and acts as a scaffold to support the artery and keep it open. After several weeks, the artery heals around the stent.

  • What happens after the carotid stenting procedure?

  • The sheath may remain in place or a vascular plug or suture may be used to achieve hemostasis.
  • You will be required to lay flat (without bending your legs) after the sheath is removed. This is necessary to prevent bleeding. Your doctor will determine how long you will have to lay flat, which could be from two to six hours.

  • After the procedure

  • To avoid bleeding from the catheter insertion site, you need to lie relatively still for several hours. You'll be either in the recovery area or in your hospital room. After the procedure, you may receive an ultrasound of your carotid artery. Most people are discharged from the hospital within 24 hours 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 take acetaminophen (Tylenol, others) in the recommended dose as needed for discomfort, or other medication as prescribed by your doctor.
  • You may need to avoid strenuous activity and heavy lifting for few days after the procedure.