The carotid arteries carry oxygenated blood to the brain. Occasionally at the origin of the internal carotid artery there can be significant atherosclerotic plaque build-up which can result in narrowing of the artery. This can cause strokes (either from small blood clots forming on the vessel wall and travelling to the brain or due to a lack of blood supply to the brain owing to the vessel narrowing). To decrease the risk of stroke a stent can be placed within the artery in order to increase the calibre of the vessel, improve the blood flow to the brain and decrease the risk of clot or plaque embolus.
How is the procedure performed?
The procedure can be performed under a light sedation or a general anaesthetic. A plastic tube (catheter) is placed into the femoral artery and navigated to the common carotid artery just below the artery narrowing. The narrowing is crossed with a small wire. A device is placed over the wire (called an embolic protection device) to decrease the risk of stroke by catching clots or particles of plaque which may be dislodged by the procedure. A special stent is then placed across the narrowed portion of the artery. Often a small balloon is then inserted to widen the stent further.
To decrease the risk of blood clots forming in the new carotid stent you will commence two antiplatelet medications 1 week prior to the operation. One of these medications is called aspirin and will need to be continued lifelong.
What are the risks or possible complications?
The most serious risk from this procedure is stroke. Stroke can result in arm or leg weakness, changes in sensation, vision or speech disturbance. Disability from stroke can be temporary or permanent. Rarely despite the stent, the blood vessel can again narrow or the stent can even block completely. This may require retreatment.
There is a small risk of bleeding within the brain due to the sudden increase in blood supply following dilation of the blood vessel with the stent.
Rarely when a balloon is expanded in the carotid artery or the stent is placed there can be pressure on nearby nerves. This can result in a slowing of the heart that may need to be treated with medications.
Other procedural risks include: Infection at the surgery site requiring antibiotics, damage to the arteries in the neck or leg which may require further treatment, bleeding and bruising at the arterial puncture site at the leg
Do I need to fast?
Yes you will be required to fast. Specific instructions regarding fasting will be provided when booking the procedure.
What happens following the procedure?
Once the procedure is complete the plastic sheath is removed and the very small hole in the artery is closed with a special stitch. You will need to stay flat in bed for 4 hours following the procedure to decrease the risk of bruising in the leg. You will then spend a short time in the recovery area after which you will be transferred to the ICU. Here blood pressure can be closely controlled and any signs of stroke or other complications can be quickly diagnosed. The day following the procedure you will be transferred to the neurosurgical ward. Patients will generally stay in hospital for one or two nights.
What follow up is required?
We will arrange a follow up appointment usually 1 week after the procedure. During this consultation Dr Bell will check for any potential complications and discuss the plan for future imaging and follow up. Dr Bell will also discuss the ongoing need for antiplatelet medications.