Carotid stenosis is a disease affecting the carotid artery causing the narrowing of lumen thus interrupting the blood flow thorough it. This may lead to stroke or cerebro vascular accident, by the blockage of the cerebral blood flow or blood supply to the brain. Carotid stenosis may also increase the chance for ischemic stroke by serving as a source of emboli or blood clot.
Cardiac endarterectomy is the traditional method used for treating this disease. This surgery is done by making a surgical incision at the neck, and the plaque at the area is taken out which will remove any stenosis of the area. But recently a different procedure has been developed and is known as carotid stenosis stenting. It is a procedure of minimal invasiveness. It has lesser complications, and the person can retrieve to his or her normal life within few days after surgery.
Carotid stenosis stenting is done under local anesthesia. 1t involves passing a very fine guide wire into the femoral artery at the groin region and slowly taking the same to the carotid artery. After inserting the wire, another catheter with small deflated balloon at its other end is passed through the same. Once the balloon reaches the stenosed part, it is inflated slowly by pushing air, and this will crumble the plaque off the site. After this a metal mesh called the stent is inserted into the artery to prevent further stenosis or narrowing and to keep the artery open. Cerebral protective measures or devices are also used in the procedure of carotid stenting. Carotid stenting if used along with carotid angioplasty will reduce the chance of restenosis several times.
Carotid stenosis stenting has various advantages. Through carotid stenosis stenting, we could minimize the chance of scarring, infection, hematoma, cranial nerve damage, etc that is very common during the surgical management. Retreatment if needed is also very easy to carry out than a challenging re-endarterectomy of the Carotid artery. There are much more outcomes for carotid artery stenting as the chance for a restenosis is found to be very less. Carotid artery stenting is also indicated for people at risk of undergoing a surgery. These include
- Patients with history of restenosis even after undergoing one or more surgery for treating the stenosis.
- Excessive scarring due to radiations
- Carotid bifurcations
- Stenotic tandem lesions of Carotid artery stenting
- Carotid lesions of intra-petrous type
Test and Examinations
Carotid stenosis stenting is a very serious procedure and should be performed by a neuro-specialist. There are many preparations to be followed while we go for a stenting. One is to do a complete neurological assessment. Patient has to be examined for any signs or symptoms of paralysis or any episodes of fainting or loss of consciousness. As in the case of any invasive procedure, blood profile, lipid, and coagulation profile, etc has to be checked in detail. CT scan or an x-ray is also taken for the same. ECG is taken prior to the procedure. The patient is put on antibiotics prior to the procedure and anticoagulants are also administered. It is very important to seek a consent from the patient or relatives which shows that they are willing for the procedure, and are ready to face any consequences that may happen as an aftermath.
The patient has to be aware of the necessity for it and the procedure should be explained properly to him. After carotid stenting, the patient should be kept under observation for a few hours and then antibiotics and anticoagulants should be continued. Level of consciousness has to be checked continuously. Glasgow’s scoring is a common method for assessing the neurological awareness. A detailed neurological assessment should be continued even after the surgery once the patient becomes conscious. Special care has to be taken to avoid any strain over the neck or head as it may compromise the blood supply to brain or increase the intra cerebral pressure. Never keep the patient in a propped position as this will increase the cerebral pressure. Special care has to be taken to avoid any infections