Carotid artery stenting is a minimally invasive method of treating carotid artery disease that has just been developed in recent years. It is usually performed under local anesthesia only, through a puncture or small incision in one femoral artery, and a small alloy stent is placed in the carotid artery stenosis with a guide wire and catheter to hold the stenosis open. The long-term results of carotid artery stenting are still controversial. However, interventional procedures are the best option for patients with more underlying disease who are not candidates for endarterectomy.
Am I a candidate for stenting?
If you have severe carotid stenosis (>60%), a history of previous mini-stroke or cerebral infarction, and are at high risk for carotid endarterectomy, you may be an indication for stenting. However, even if you have no previous symptoms, if you have >80% carotid stenosis and are at high risk for endarterectomy, you are still an indication for stenting. In addition, stenting should also be an option in cases of restenosis after endarterectomy.
Stenting is not indicated in the following cases
Expected survival time less than 2 years
Severe arrhythmias
allergy to contrast media
history of cerebral hemorrhage within 2 months
Complete occlusion of the carotid artery
What are the risks of stenting?
Postoperative cerebrovascular embolism is a rare and serious complication of stenting, caused by thrombus emboli or plaque debris embolizing the cerebral vessels with blood flow and can lead to stroke. Other complications that can lead to stroke include in-stent thrombosis or a tear in the intima of the carotid artery caused by the procedure, called arterial entrapment. Carotid artery restenosis is another possible complication. In addition, the contrast agent applied intraoperatively can be damaging to the kidneys, especially in patients with previous kidney disease. Hematoma or pseudoaneurysm occurring at the puncture site of the groin or upper extremity are also rare complications. Petechiae or skin bruising at the puncture site are more common and usually disappear quickly.
What are the conditions that can increase the chance of complications?
Factors that increase the chance of complications during stenting include
Hypertension
Long calcified carotid stenosis
Severe angulation or other anatomical abnormalities of the carotid artery
Unstable plaque
Significant calcification of the aortic arch at the beginning of the carotid artery
Age over 80 years
Severe stenosis of the upper or lower extremity vessels
Renal insufficiency
What do I need to prepare before surgery?
Before surgery, your doctor will explain to you what you need to be aware of, such as fasting. You should inform your doctor of any medications you are taking.
Usually, your doctor will give you oral medications such as aspirin 3-5 days before surgery to prevent blood clots from forming in the stent after surgery. Your doctor will also perform an ultrasound, CT, angiogram or MRA to assess the degree of carotid stenosis before the procedure.
How is carotid artery stenting performed?
The procedure is usually performed under local anesthesia. Before the procedure, you will be asked to hold a toy that makes sounds so that your nerve function can be readily understood during the procedure. You will be given heparin to prevent intraoperative thrombosis and atropine to lower your heart rate.
When the procedure begins, local anesthesia is first administered to the puncture site (usually the groin). After successful anesthesia, the surgeon performs a femoral artery puncture and then inserts a thin guidewire along the vessel into the carotid artery, during which you will not feel any pain because there are no nerves in the vessel. The doctor then uses an angiogram to understand the carotid artery lesion. Next, the surgeon will place a small screen over the lesion through the guidewire, which we call the cerebral umbrella, to intercept the debris of the dislodged plaque to prevent the small plaque from entering the cerebral vessels with the blood flow and causing a cerebral embolism. Afterwards, the surgeon will place a balloon along the guidewire into the carotid stenosis and dilate the stenosis by expanding the balloon.
After the above operation is completed, the surgeon withdraws the cerebral umbrella and other guidewires and catheters, compresses the puncture site for 15-30 minutes to prevent bleeding, and finally dresses the wound with pressure.
What should I pay attention to after the operation?
When you return to the ward, you should try to keep the limb on the punctured side straight and refrain from extensive movement to prevent bleeding from the puncture site. In addition, you should drink plenty of water to allow the contrast medium to drain quickly. From the day after the procedure, you may be given anti-platelet medication (such as aspirin or poliovel) to prevent blood clots from forming. After 24 hours, your doctor will release the wound pressure dressing and you can get out of bed properly.
How will I stay healthy after I leave the hospital?
If you do not need surgery, you and your family should always be aware of any symptoms of transient ischemic attack. Take medications as recommended by your doctor, such as aspirin to lower your blood viscosity and statin lipid-lowering medications to control your blood lipids. You should also pay attention to regular exercise, quit smoking, control blood pressure and blood sugar, and have a low salt and low fat diet. Regular outpatient follow-up.
If you have undergone surgical treatment or stenting, you should take antiplatelet drugs strictly and regularly as recommended by your doctor after surgery, and follow up regularly at the clinic to keep an eye on the occurrence of cerebral ischemia symptoms.