The carotid arteries—located on each side of your neck—supply vital blood to your brain. Carotid artery disease occurs when the carotid arteries narrow or become blocked, reducing blood flow to your brain. Carotid stenting is a procedure in which your vascular surgeon inserts an expandable metal coil called a stent inside your carotid artery at the location of a blockage. The stent expands inside your carotid artery to increase blood flow in areas blocked by plaque. Carotid stenting can help to reduce your chance of stroke. The experts at the Ohio State Heart and Vascular Center use the latest techniques in carotid stenting to treat artery blockage, right here in Columbus.
Conditions treated
Carotid stenting is approved to treat patients who:
- Have carotid artery disease
- Have had symptoms of transient ischemic attack or stroke
- Have a significantly narrowed carotid artery (typically by more than 70%)
- Are too high risk for standard carotid endarterectomy
Carotid artery disease
Causes
Carotid artery disease is caused by plaque (a sticky substance made up of cholesterol, calcium and fibrous tissue) in the carotid artery. A buildup of plaque causes the artery to narrow and harden, resulting in reduced blood flow to the brain.
There are things you can do to reduce your risk of developing carotid artery disease:
- Control your blood pressure
- Control your blood sugar levels
- Eat a healthy diet, low in saturated fat
- Exercise regularly
- Maintain a healthy cholesterol level
- Maintain a healthy weight
- Quit smoking
Symptoms
Often, there are no symptoms associated with the beginning stages of carotid artery disease, and unfortunately, stroke can sometimes be the first sign. Warning signs of a stroke can include:
- Sudden weakness, tingling or numbness on one side of the body
- Inability to control movement of one or more limbs
- Loss of vision in one eye
- Slurred speech or loss of ability to speak
Even if these symptoms resolve quickly, they indicate a strong possibility of an impending stroke. If you experience any of these symptoms, contact your physician immediately.
Diagnosis
Your physician uses a stethoscope to listen to your carotid arteries. They will listen for a bruit (whooshing sound) that indicates reduced blood flow. During this visit, your physician will also ask about symptoms you’ve experienced and identify if you have any conditions that increase your risk of developing carotid artery disease.
After performing a physical exam and learning about your symptoms and medical history, your doctor may choose to test for carotid artery disease. You may undergo one or more routine tests.
Treatments – Nonsurgical
Your physician may recommend lifestyle changes such as quitting smoking, beginning an exercise regimen and lowering saturated fat in your diet to stop carotid artery disease from progressing. They may also recommend medications such as aspirin to thin your blood or statins to control blood lipid (fat) levels.
Treatments – Surgical
If you’re experiencing warning signs of a stroke, have experienced a stroke or have severe narrowing of the arteries with or without symptoms, you may need to undergo surgery. Surgical procedures include:
- Carotid endarterectomy – The surgeon makes an incision in your neck to remove plaque from the inner lining of your carotid artery. This is a safe procedure that requires general anesthetic and yields long-lasting effects.
- Carotid stenting
What to expect during carotid stenting
Preparing for your procedure
To prepare for carotid stenting, you should tell your physician about any medications you’re currently taking, including aspirin or any other over-the-counter blood-thinning medications. Your heart specialist may ask you to take aspirin and a prescription blood-thinning medication called clopidogrel for a few days before your procedure. You’ll need to fast (avoid eating and drinking) prior to your procedure.
During your procedure
You’ll lie on a special X-ray bed in an angiography procedure room or a catheterization lab. You’ll be connected to a monitor that shows your heart rate and blood pressure.
During the procedure, your surgeon may talk with you or instruct you to squeeze a small toy or ball so that he or she can monitor your brain function. Your surgeon will inject a dye into your arteries and then take X-rays to locate the narrowed areas in your arteries.
Your surgeon may perform an angioplasty prior to inserting the stent. During angioplasty, your surgeon inserts a catheter (long, thin tube) with an attached balloon into a small incision or puncture over an artery in your arm or groin. Your surgeon guides the catheter to the blockage site in your carotid artery.
Your surgeon may insert a small balloon called an embolic protection device to help prevent strokes by catching the clots or debris that may break away from the plaque during the procedure. The angioplasty balloon flattens the plaque and widens the space where the blood flows through. After the artery is open, your surgeon will remove the catheter.
Using another catheter, your surgeon guides a compressed stent to the same area in your carotid artery and then releases it. The stent expands to fit the artery. Your surgeon then removes the stent-carrying catheter and any embolic protection devices. Stents remain permanently in your carotid artery.
Carotid stenting usually takes one to two hours, but may take longer in some circumstances.
After your procedure
Immediately following the procedure, your surgeon or nurse will apply pressure to the catheter insertion site in the groin or arm to allow it to close and prevent bleeding.
Your instructions will likely include:
- Don’t lift anything more than 5 to 10 pounds after you return home
- Don’t take a bath for a few days (showering only)
- Drink water to help flush the dye out of your system
- Take blood-thinning medications
- Schedule periodic follow-up examinations to monitor the function of your stent
Why Choose Ohio State for carotid artery disease treatment?
Physicians at the Ohio State Wexner Medical Center have expertise in treating carotid artery disease. Our vascular physicians are experts at treating carotid disease with either surgery or stenting and are well-equipped to recommend the best treatment for each individual patient. Through our participation in ongoing research registries, we have access to all available carotid stenting equipment for patients that would be best served with a carotid stent.
We educate our patients about lifestyle habits and medications that may keep the disease from progressing. Ohio State is home to skilled physicians who perform surgery as well as minimally invasive procedures to treat all stages of carotid artery disease.