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Vascular Center

 

Carotid Artery Stent


What is carotid artery disease?

Your carotid arteries are the blood vessels that supply your brain with most of the blood it needs to work. You have two carotid arteries, one on each side of your neck. Carotid artery disease is when one or both of the carotid arteries becomes narrowed or blocked.

Carotid artery disease is caused by the build-up of plaque (fat) inside the artery. This build-up of plaque is called atherosclerosis (ath-er-oh-skle-ROH-sis), or hardening of the arteries.  View a brochure (.pdf) for more information.                                               
                                
Who is at high risk of getting carotid artery disease?

You are more likely to develop carotid artery disease as you age. Males have carotid artery disease more often than females. Other things that increase your chance of having carotid artery disease include:

Family history: You are more likely to have problems if atherosclerosis or stroke runs in your family.

Heart disease: Atherosclerosis can cause narrowing of the arteries in the heart as well as the carotid arteries.

Other health problems: You are more likely to have carotid artery disease if you have high blood pressure, high cholesterol (koh-LES-ter-ol), diabetes, or problems with blood circulation.

Smoking: Smoking causes your arteries to narrow and decreases the amount of oxygen in your blood. Smoking also damages the walls of your arteries, which may allow blood clots to form. Smoking increases your risk of having a heart attack, stroke, and other serious health problems.

How is carotid artery disease diagnosed?

Carotid bruit: When blood flows through a narrowed carotid artery, it often makes a loud "whooshing" noise. Your caregiver may hear this noise, called a bruit (BREW-eee), through a stethoscope placed on your neck.

Carotid ultrasound: This is a test using sound waves to see your carotid arteries. This test helps your caregiver see narrowing or blood flow problems.

CT scan: This test is also called a "CAT" scan. A special x-ray machine uses a computer to take pictures of the inside of your head and neck. This test can help caregivers see if your carotid artery disease has caused problems in the brain. Another CT test that may be done is called CT angiography (an-gee-OG-ruh-fee), which looks at your carotid arteries.

Arteriography: Arteriography (ahr-te-ree-OG-rah-fee) is an x-ray test of the carotid arteries. A special dye is injected into an artery in your leg or arm. The dye helps the carotid arteries show up better in the x-ray pictures.

Magnetic resonance imaging/Magnetic resonance angiography: Magnetic resonance (RES-oh-nans) angiography (an-jee-OG-rah-fee) is also called a MRA test. This test uses a large magnet and radio waves to see images of your carotid arteries on a computer screen. Contrast is injected into a vein so that the carotid arteries show up better in the pictures.

How is carotid artery disease treated?

The treatment you receive depends on how narrow your arteries have become, your symptoms, and your general health. The goal of treatment is to lower your risk of having a stroke. You may receive the following treatments alone or together:

Medications:  Caregivers may suggest that you take Aspirin, Plavix, and/or cholesterol lowering medications.  Aspirin and Plavix help to prevent blood clots from forming in the carotid arteries.  If your caregiver wants you to take aspirin, do not substitute Ibuprofen (eye-bu-PROH-fen) or Tylenol/Acetaminophen (a-seet-a-MIN-oh-fen) in its place.

Control risk factors: Cigarette smoking, high blood pressure, high cholesterol, heart disease, diabetes, and being overweight increase your risk of atherosclerosis. Ask caregivers for help controlling these conditions. Also, smoking causes blockages in the arteries throughout your body in many different ways. With time, this can cause a stroke or a heart attack. It is very important to stop smoking.

If you smoke or use tobacco products, "PLEASE STOP NOW!"
For assistance, call the Maine Tobacco HelpLine
at 1-800-207-1230

Carotid endarterectomy (end-ahr-ter-EK-toh-mee): Your surgeon makes an incision in the front of the neck into the carotid artery. The plaque is cut out of the artery, which gives the blood more room to flow. The artery is then sewn back together.

Angioplasty: For this procedure, your doctor makes a small puncture into an artery (usually in the groin area). A small catheter with a balloon on the end is sent up into the carotid artery. The caregiver inflates the balloon to push the plaque against the artery wall and make more room for blood to flow. This process is called angioplasty (AN-jee-oh-plas-tee).

Carotid Artery Stent:  Carotid artery stenting is a procedure where a tiny wire-mesh stent is inserted in the carotid arteries to allow oxygen rich blood to flow to the face and brain. Stents have been used for years to keep arteries open in the heart and in other areas of the body. 

Risks:

Carotid artery disease may increase your risk of having a stroke. A stroke (or "brain attack") happens when your brain is injured due to a lack of blood flow. A stroke can happen if a carotid artery becomes too narrow or blocked. Blood clots or plaque fragments from a carotid artery may travel to the brain and cause a stroke. A stroke is a serious medical condition and may even be life-threatening. People who have had one or more transient ischemic attacks (TIA's) are also at higher risk of having a stroke.  Symptoms of a TIA are similar to those of a stroke.  They may include:

  • Sudden, temporary loss of vision in one eye
  • Loss of balance or coordination
  • Numbness or weakness on one side of the body
  • Slurred speech or difficulty speaking
  • Change in ability to use arms and legs
  • Facial droop (one side of the face seems to sag)
  • History of stroke

Unlike a stroke, a TIA does not cause lasting symptoms. Symptoms usually go away after 10 to 20 minutes, although they may last up to 24 hours. A TIA is considered a warning sign of an impending stroke.

Carotid artery disease does not cause heart attacks. However, if you have carotid artery disease your risk of having a heart problem is increased. This is because the atherosclerosis which caused your carotid artery disease may also narrow the arteries around the heart. 

Preparation for having a Carotid Artery Stent placed

Preparing your mind for your procedure...You have a part to play: Most people have some anxiety and stress when they come to the hospital for a procedure. Maine Medical Center offers a free program to help prepare you to cope with these feelings. Relaxation skills can help you to recover more quickly. You can actively take part in your own healing process. Our program, based on Herbert Benson's Mind Body Institute, will teach you many simple mind/body exercises. You will have the chance to develop a personal plan that best meets your needs. People who use our exercises report the ability to cope better before, during and after their procedure.

This program will help you:
- Feel calmer before your procedure
- Feel less discomfort
- Feel more in control
-

Recover more quickly

   
Relaxation techniques:
- Breathing exercises
- Music
- Imagery
- Positive thinking

Our program is free to any person waiting to have procedures or tests. This one hour class is taught by Advanced Practice Nurses skilled in using and teaching relaxation techniques for therapeutic benefits.

If you wish to attend this program, please register by calling Pat Todorich, APRN, BC, at Maine Medical Center, 207 662-2425.

  • Allergies: Please let your doctor and nurse know if you have any allergies to food or medications especially shellfish.
  • Eating and Drinking: Please do not eat or drink anything after midnight. You may take small sips of water with your medications.
  • Medications: Your nurse will give you an Aspirin and Plavix before the procedure. If you are taking Coumadin, this medication will be stopped several days prior to your admission.

An intravenous (IV) line will be inserted in your arm so that medications and fluids can be given to you during the procedure.

What happens during carotid stenting?

Before the procedure begins, the medical staff will connect you to a monitor that shows your heart rate and a blood pressure cuff will be attached to your arm to monitor your blood pressure during the procedure. A small clip will be attached to your finger to monitor the oxygen level of your blood.

You will be awake during the procedure and you may be given medication to help you relax. The site where your doctor accesses your artery to perform the procedure will be numbed to decrease discomfort. Your doctor will frequently check on you throughout the procedure. Please let him/her know if you are experiencing any numbness, chest discomfort, blurred vision, and headache or any other symptoms.

Your physician will locate the narrow areas in your arteries by injecting contrast into your arteries and taking x rays. The contrast allows the physicians to see your arteries and any blockages you have inside your arteries. Then, your physician will insert a filter which helps to prevent strokes by catching any clots or debris that may break away from the plaque. Next, your physician will stretch the blockage using a balloon placed over a catheter, and insert the stent to keep the carotid artery open. You will not feel the catheters as they move through your arteries because there are no nerve ending inside your arteries. Carotid stenting usually takes about 1-2 hours but may take longer in some circumstances.

Are there any complications? 

Blockage by a clot or other debris in an artery in your brain, called an embolism, is one of the most serious complications that can occur after carotid stenting. This blockage can cause a stroke. Another complication that may cause a stroke is a blood clot forming along the stent. The re-blockage of the carotid artery, called restenosis, is another possible complication. The contrast used for the angiogram can sometimes cause damage to the kidneys, especially in people who already have kidney trouble. Bleeding from the arterial puncture site in the groin or arm, called a hematoma or a false aneurysm, can also occur but this is unusual. Bruising at the puncture site is common, however, and usually resolves with time. Your doctor will discuss possible risks and complications of treatment options with you prior to your making any decisions.

What can I expect after carotid stenting?

Immediately after the procedure, your physician may apply a cork-like closure device that will help seal the artery. You will need to lie flat with your head of bed elevated 30 degrees for 3- 6 hours following the procedure.

Your nurse will ask you to drink plenty of fluids to remove the contrast material from your body. In addition, you will be instructed not to lift anything more than 10 pounds (bag of groceries) for 1 week after your procedure to avoid any pressure on the incision. You may shower anytime after your procedure but should not soak in a tub, whirlpool, hot tub or go swimming for 1 week. Detailed Carotid Artery Stent discharge instructions will be provided to you prior to discharge from the hospital

 
 
 
How can you lower your risk?
 
Health Information

22 Bramhall Street | Portland, Maine 04102-3175 | (207) 662-0111