Having a carotid artery stent

Introduction including who the leaflet is for and what is its aim

This leaflet is for patients who have been told they require a carotid artery stent.

About carotid artery stenting

Carotid artery stenting is a procedure in which a slender, metal-mesh tube, (a stent), is inserted and expanded inside the carotid artery to increase blood flow through a section of the artery which has become restricted.

Am I a candidate for carotid stenting?

Carotid stenting has been approved for the treatment of patients with symptomatic carotid artery disease who are considered to be too high a risk for carotid surgery (endarterectomy). You may be a candidate for the procedure if your carotid artery is significantly narrowed (usually by more than 60 percent), if you have had symptoms of a mini-stroke or stroke and are considered high risk for carotid surgery.

Even if you have no symptoms, you may be also a candidate if your carotid artery is severely narrowed (by more than 80%) and you are considered high risk for carotid surgery.

If you have developed a new narrowing after carotid surgery you may also be a candidate.

Who will perform my procedure?

This procedure will be performed by a consultant neuro-radiologist.

Before your procedure

You will be admitted to the ward before your procedure.

We will ask if you take any tablets or use any other types of medication either prescribed by a doctor or bought over the counter in a pharmacy. Please bring all your medications and any packaging (if available) with you. Please tell the ward staff about all of the medicines you use. If you wish to take your medication yourself (self-medicate), please ask your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

You must tell us if you are taking warfarin. Please call 01223 245151 extension 596382.

Most people who have this type of procedure stay in hospital for one night. Your doctor will discuss the length of stay with you.

The procedure

The procedure takes place in the angiography suite and is usually performed under local anaesthetic while you are awake and alert. You will first be connected to a monitor that shows your heart rate and blood pressure. During the procedure, the Radiologist will talk with you and may ask you to squeeze a small toy or ball so your brain function can be monitored.

The Radiologist will give you a local anaesthetic to numb the catheter insertion area. The narrow areas in your arteries can then be located by injecting a dye through the catheter and taking live x rays, called fluoroscopy.

Once the site of narrowing is found, the Radiologist will use another catheter to position and release the stent. The stent expands to fit the artery. In most cases the Radiologist then uses a balloon catheter to further expand the stent against the wall of the artery. The catheter is then removed, leaving behind the stent.

The arterial puncture site is sealed with a stitch applied through a small catheter.

The whole procedure usually takes about one hour.

After the procedure

After the procedure you will be transferred to a recovery ward where you will be looked after by specially trained nurses. They will monitor your heart rate, blood pressure and oxygen levels. You may be given oxygen via a facemask, fluids via your drip and appropriate pain relief until you are comfortable enough to return to your ward.

You will have to stay in bed for several hours while the puncture site heals.

Local anaesthesia

In local anaesthesia the local anaesthetic drug is injected into the skin and tissues at the site of the operation. The area of numbness will be restricted. Some sensation of pressure may be present, but there should be no pain. Local anaesthesia is used for minor operations such as stitching a cut, but may also be injected around the surgical site to help with pain relief. Usually a local anaesthetic will be given by the doctor doing the operation.

Benefits

The aim of the procedure is to reduce the risk of stroke.

Risks

• Blockage of an artery in your brain by a clot or other debris is called an embolism. This is the most serious complication that can occur after carotid stenting and can cause a stroke.
• Bleeding from the puncture site in the groin or arm artery can be serious and necessitate surgical repair, but this is unusual.
• Bruising and mild tenderness at the puncture site is common, but usually resolves with time.

Alternatives

The alternative procedures will have been discussed with you by the vascular surgeons before being referred for a stent. Patients with carotid artery stenosis are either treated surgically (endarterectomy), by best medical therapy via medications or decline treatment altogether.

Radiation – Risks vs Benefits

• You have been referred for a Neuro Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.
• The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.
• Ionising radiation can cause cell damage that may turn cancerous however the risk of this happening from your examination is considered low.
• Depending on the length of the procedure there may also be a small risk of an excess radiation dose to the skin leading to short term and long term effects (e.g. reddening of the skin and burns).
• If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable
• For further information please see the Visit the Imaging pages on our website

Conclusion

• Some of your questions about your procedure should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP

Please tell the ward staff about all of the medicines you use. During your stay If you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

My Chart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: My Chart

Contacts/Further information

Please call the clinical nurse specialist on telephone number 01223 596382 if you have any questions or concerns about this procedure or your appointment.