Patient Information - Carotid Disease

'The information contained in this patient information sheet is not a substitute for medical advice or treatment, and the Society recommends consultation with your doctor or health care professional'

1. Why do I need the treatment?

The aim of carotid stenting is to prevent you having a stroke in the future.
You may have had a TIA (mini-stroke). This is often due to a narrowing of the main artery to your brain, the carotid artery, in your neck. There is a risk that you may suffer a further stroke in the future.
In some circumstances, even if you have not had a TIA, the specialist involved in your care may still recommend treatment to the narrowed carotid artery to reduce the risk of stroke in the future.

2. Before the treatment

The x-rays or scans of the carotid artery should already have been done. On the day of the procedure you will be assessed by the medical staff and some paper work including consent for the procedure will be finalised. Some blood tests and an ECG may be required.

Please bring with you all the medications that you are currently taking. You will be admitted to your bed by one of the nurses who will also complete your nursing record.

3. Preparation for the treatment

A drip is usually placed into a vein in your arm.
You may be given a small amount of sedation, and as a result, you may not remember a lot about the procedure afterwards.
Sometimes, a second drip will be placed into an artery at wrist level to permit careful blood pressure monitoring during and just after the procedure.
Carotid stenting is usually performed under local anaesthetic. This will be in a room with specialised x-ray equipment either in the x-ray department or operating theatre. The procedure involves passing wires and small diameter plastic tubes inside the arteries under x-ray control. These are usually introduced via the artery in the groin, the femoral artery. An injection of anaesthetic into the skin over the pulse in the groin is given. A needle is then used to enter the artery. A wire can be passed down the needle into the artery. The plastic tube (catheter) is then threaded onto the wire and into the artery.

4. The Procedure.

The wire inside the artery is carefully passed up to the carotid artery just below the narrowed area. As the wire passes through the narrowed section, the medical and nursing staff will monitor you carefully to make sure this is not causing you any problems. They may ask you to talk and move your arm/hand.
You may be able to see the progress of the procedure on a television monitor.
Over the wire, a special catheter is passed over the narrowed area. This has two functions. One part of the catheter acts as a protection device to stop any small clots or debris passing to the brain causing more TIA’s. The other part of the catheter has a balloon with a metal stent over it. The balloon and stent are carefully placed across the narrowed section of the carotid artery.
Inflation of the balloon dilates the artery, opens up the stent, and embeds the stent into the carotid wall. During this you may feel some brief discomfort in the neck.
Some patients feel a little light headed since the stretching of the artery can cause the blood pressure to decrease. This can be corrected by fluid and medication given via the drip in your arm if necessary.
The balloon is deflated and removed leaving the stent supporting the artery wall, helping to keep it open.
Following this a check x-ray is done to make sure the narrowed section has been successfully dilated and that the stent is in a good position.

5. After the Treatment

You will be returned to the ward for observation. A check of your pulse and blood pressure is made regularly. The nursing staff will also check your speech and movements to make sure they are normal.
For the first 1-2 hours it is best to rest. This is partly to prevent any bruising or bleeding from the groin where the catheter was placed into the artery. The nursing staff will then let you get up and move around providing your observations are satisfactory.

6. Going home

Most people stay in hospital overnight and go home the following morning. In some cases you may be allowed home the same day.
You can return to normal activities as soon as you feel comfortable. If the groin is bruised this will usually clear in 5-7 days.
Medicines: You will usually be sent home on a small dose of aspirin if you were not already taking it. This makes the blood less sticky. You may also be given a second medicine called Clopidogrel which has a similar effect to aspirin. No other changes to your medication are required.

7. Complications

Stroke: A small number of people, between 1 and 3 in 100, undergoing carotid stenting will have a stroke during or shortly after the procedure. All possible precautions will be taken to prevent this eventuality.
Bleeding causing a collection of blood around the artery in the groin can occur but is rarely a major problem. In 1-2% of cases this needs to be removed by a small operation, but usually the blood is removed by the body over a period of 1-2 weeks.
Allergic reactions to the x-ray dye rarely occur.
If you have other medical conditions such as angina or bronchitis/asthma these conditions may be exacerbated at the time of stenting. This is rarely a major problem.

8. What can I do to help myself?

If you are a smoker you should make a determined effort to stop completely. Continued smoking will cause further damage to your arteries and increases the risks of heart attacks, strokes, and problems with the circulation in your legs.
General health measures such as reducing weight, a low fat diet and regular exercise are also important.

9. Further Questions

If you have further questions, please do not hesitate to ask either your Consultant or one of his team, or the Nurses who are looking after you on the ward.

The Vascular Society is grateful to Mr Simon Parvin and members of the Audit and Research Committee for writing this information leaflet. March 2006

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