Carotid Stenting
Carotid stenting is a minimally invasive procedure aimed at preventing stroke, one of the leading causes of death and disability worldwide. The carotid arteries, located on either side of your neck, are the main blood vessels that supply blood to the brain. Over time, these arteries can become narrowed or blocked due to the build-up of plaque—a condition known as carotid artery disease. When the flow of blood to the brain is restricted, it increases the risk of stroke. Carotid stenting offers a way to open narrowed arteries and improve blood flow to the brain, thereby reducing the risk of stroke.
Understanding Carotid Artery Disease
Carotid artery disease is often silent and goes unnoticed until it is severe enough to provoke a stroke or transient ischemic attack (TIA). Risk factors for the development of carotid artery disease include high blood pressure, high cholesterol, diabetes, smoking, and a family history of atherosclerosis or coronary artery disease.
Why it’s done
Before delving into why carotid stenting is performed, it’s essential to understand carotid artery disease. The carotid arteries are located on each side of your neck and are essential for supplying oxygen-rich blood to your brain. When these arteries are narrowed or blocked by plaque, the blood flow to the brain is compromised, significantly increasing the risk of stroke, a leading cause of death and disability worldwide.
Reasons for Carotid Stenting
Carotid stenting is primarily done to prevent strokes in people with significant carotid artery narrowing. Here are the primary reasons why this procedure is recommended:
Prevention of Stroke: The most compelling reason for carotid stenting is to lower the risk of stroke. Strokes can occur when a part of the brain is deprived of oxygen and nutrients due to reduced or blocked blood flow. By opening up the narrowed artery, stenting ensures better blood flow to the brain, thereby reducing the risk of stroke.
Symptomatic Carotid Artery Disease: Patients who have experienced transient ischemic attacks (TIAs) or minor strokes due to moderate to severe carotid artery narrowing (usually 70% or more) may be candidates for carotid stenting. TIAs are often considered warning strokes, indicating a high risk of a full-blown stroke in the future.
Asymptomatic Carotid Artery Disease: In some cases, carotid stenting might be considered for individuals with significant carotid narrowing (70% or more) who have not experienced any symptoms. The decision is usually based on the patient’s overall health, life expectancy, and specific characteristics of the artery narrowing.
High Surgical Risk Patients: Carotid stenting may be an alternative to carotid endarterectomy (a surgical procedure to clear the carotid arteries) for patients considered at high risk for surgical complications due to other medical conditions, such as heart disease, lung disease, or previous neck surgeries.
The Carotid Stenting Procedure
Carotid stenting is typically performed under local anesthesia. The procedure involves making a small puncture, usually in the femoral artery in the groin. A catheter (a thin, flexible tube) is then inserted through this puncture site and navigated through the vascular system to the narrowed section of the carotid artery. Once in place, a balloon attached to the catheter is inflated to open up the narrowed artery. A stent (a small, wire mesh tube) is then deployed to keep the artery open. The stent remains in the artery permanently, acting as a scaffold to support the artery walls and prevent them from narrowing again.
Benefits and Risks
The primary benefit of carotid stenting is its ability to significantly reduce the risk of stroke in people with significant carotid artery narrowing. It is particularly beneficial for patients who are considered at high risk for traditional carotid endarterectomy surgery due to other medical conditions or previous surgeries.
However, like all medical procedures, carotid stenting carries certain risks. These include the risk of stroke or mini-stroke during the procedure, bleeding at the catheter insertion site, and the rare possibility of the stent becoming blocked over time.
Recovery and Post-Procedure Care
Recovery from carotid stenting is relatively quick, with most patients able to return home within 24 to 48 hours after the procedure. Post-procedure care includes taking prescribed medications, such as antiplatelet drugs, to prevent blood clots around the stent. Regular follow-up appointments are necessary to monitor the stent and the overall health of the carotid arteries.
Who Is a Candidate for Carotid Stenting?
Not everyone with carotid artery disease is a candidate for carotid stenting. The procedure is typically recommended for patients who have experienced symptoms of carotid artery narrowing, such as a TIA or minor stroke, and have at least a 70% narrowing of one or both carotid arteries. The decision to proceed with carotid stenting also depends on the patient’s overall health, the location of the blockage, and the risk of complications from surgery.
Food and medications
When considering carotid stenting, it’s crucial to understand the impact of food and medications before and after the procedure. Both play significant roles in preparing for the procedure, ensuring its success, and facilitating a smooth recovery. This section explores the dietary considerations and medication management associated with carotid stenting, offering guidance for patients and caregivers.
Before Carotid Stenting
Food
Prior to undergoing carotid stenting, patients may be advised to fast for a certain period, typically overnight or at least 6-8 hours before the procedure. This fasting helps prevent the risk of aspiration (inhaling food or liquid into the lungs) during sedation. It’s essential to follow the specific instructions provided by the healthcare team regarding food and drink.
Medications
Blood Thinners: Patients taking blood-thinning medications (anticoagulants and antiplatelet drugs) will receive specific instructions from their healthcare provider on how to manage these medications before the procedure. In some cases, blood thinners may need to be adjusted or temporarily stopped to reduce the risk of bleeding during and after stenting.
Diabetes Medications: Individuals with diabetes may need to adjust their medication and insulin dosages due to fasting before the procedure. It’s important to closely coordinate with the healthcare team to ensure blood sugar levels are managed safely.
After Carotid Stenting
Food
Post-procedure dietary recommendations focus on promoting overall vascular health and preventing the progression of atherosclerosis, the underlying cause of carotid artery disease. A heart-healthy diet, rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, is generally advised. This type of diet supports the health of the arteries and can help manage cholesterol levels, blood pressure, and body weight.
Medications
Antiplatelet Therapy: After carotid stenting, patients are typically prescribed antiplatelet medications to prevent blood clots from forming within the stent. Commonly prescribed medications include aspirin and clopidogrel (Plavix). It’s crucial to take these medications exactly as prescribed to minimize the risk of stroke.
Cholesterol-Lowering Medications: Statins or other cholesterol-lowering drugs may be prescribed to manage cholesterol levels and reduce the risk of plaque buildup in the arteries.
Blood Pressure Medications: Controlling blood pressure is key to preventing further damage to the cardiovascular system. Patients may be prescribed medications to keep blood pressure within a healthy range.
Lifestyle Modifications
In addition to dietary changes and medication management, lifestyle modifications such as regular physical activity, smoking cessation, and weight management are crucial for long-term success after carotid stenting. These changes can help slow the progression of carotid artery disease and improve overall cardiovascular health.
Conclusion
Carotid stenting represents a significant advancement in the treatment of carotid artery disease, offering a less invasive option than traditional surgery with a quicker recovery time. It plays a crucial role in stroke prevention for many patients. However, it’s important for patients to work closely with their healthcare provider to determine the best treatment plan based on their specific condition and risk factors. Regular check-ups and adherence to a healthy lifestyle are also key components of managing carotid artery disease and reducing the risk of stroke.
DR. ALOK KUMAR UDIYA
Well-known Interventional Radiologist Dr. ALOK KUMAR UDIYA is currently a consultant at The CARE CHL, an Indore hospital with NABH accreditation. He has a distinguished medical career and has studied at numerous top federal, state, and international superspecialty medical institutes.
He earned his M.B.B.S. from M G M Medical College in Indore and then M.D. in radiodiagnosis from Lady Hardinge Medical College at Delhi University.
Following that, he completed a fellowship in neuro- and vascular interventional radiology at the Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) in Lucknow, where he gained extensive experience in diagnostic imaging along with hepatobiliary, peripheral vascular, and neurovascular interventions.
The prestigious Institute of the liver and biliary sciences Hospital (ILBS), New Delhi, awarded him a P.D.C.C. (Post Doctoral fellowship) in Hepatobiliary intervention, where he also received further in-depth instruction and advanced training in hepatobiliary and transplant imaging and interventions.
Moreover, he completed a six-month Neuro-Interventional Fellowship (FINR) at the famous University of Zurich, where he received specialized training from Professor Anton Valavanis in the endovascular management of stroke and aneurysm. https://cvicvascular.com/
Contact Us
Contact No. – 099993 78980
Email – dralokudiya@gmail.com
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Care CHL
Address – AB Rd, near L.I.G Square, RSS Nagar, Indore, Madhya Pradesh 452008
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