Carotid Stenting

Blockages from atherosclerosis (hardening of the arteries) often occur in the blood vessels in the neck (carotid arteries). Blockages in the carotid arteries can result in a stroke if not properly fixed. The most common way to fix these blockages is with a surgical procedure to open or clean the carotid artery (carotid endarterectomy). However, some patients may not be candidates for this procedure. For them, we recommend carotid stenting to open the blocked vessel and restore blood flow to the brain.

What happens during carotid stenting?

You will have already discussed the treatment options with your physician doing the procedure and are probably already be taking or will be placed on, special medications (Aspirin and Plavix to thin your blood).

Prior to your procedure, we’ll take you to a preparation area where our nurses will start an IV in your arm and give you any medication that may be required prior to your procedure. We may give you medicines to protect your kidneys, antibiotics to help prevent infection, and anti-nausea medications. You may have a Foley catheter (tube) placed into your bladder.

You will be taken to a special room similar to an operating room. We sometimes use general anesthesia, so you may not be aware of the remainder of the procedure. For some patients, we use conscious sedation, or mild anesthesia, in which you remain slightly awake.

During the procedure, you’ll lie on your back on a table and we’ll clean the area where the catheter (a thin, hollow tube) will enter your body using a special solution to minimize infection. We’ll place sterile drapes over your body and the interventionalist will apply a local anesthetic so you don’t feel any pain.

Your neurointerventionalist will make a small incision, usually in your groin or upper thigh to insert the catheter. Using imaging techniques—usually with a contrast dye—we’ll navigate the catheter to the blood vessel in the neck. At that point, the neurointerventionalist will insert a small device that looks like an umbrella (an embolic protection device, or EPD) to catch any little fragments that may break off from the plaque in the blockage. Your neurointerventionalist will then partially open the blood vessel with a small balloon and implant a stent to help keep the blood vessel open. Finally, we’ll insert a larger balloon to open the blocked blood vessel completely (angioplasty).

At the end of the procedure, your neurointerventionalist will withdraw the EPD and catheters and apply pressure or place a special device in the blood vessel to stop the blood from leaking out. Finally, we’ll put a bandage over the incision.

After your procedure, your neurointerventionalist will review the results of your carotid stenting with you and your physician so he or she can discuss the next steps with you.