What is endovascular carotid stent placement?

Endovascular carotid stent placement is a procedure to open a blocked carotid artery. There are two carotid arteries-one on each side of the neck-that supply blood to the brain. Fatty buildup (plaque) can narrow or block these arteries. When one or both of your carotid arteries are blocked, it can make it hard for blood to flow to the brain. This procedure may improve blood flow to your brain and lower your risk of having a stroke.

Before the procedure you will get medicine to prevent pain and help you relax. The doctor will put a small tube, called a catheter, into a blood vessel in your groin. He or she will move the catheter through the blood vessel to your carotid artery. The doctor will put dye into the catheter. The dye will make your carotid artery show up on X-ray pictures so the doctor can find the blocked section of the artery.

The doctor will put a catheter with a tiny balloon at the tip into your carotid artery. He or she will inflate the balloon. This will stretch the narrowed part of the artery. The doctor will take the balloon out.

Then the doctor will use the catheter to put a small, wire-mesh tube (stent) into the carotid artery. The stent will hold the artery open. The stent also may keep small pieces of plaque from breaking off and causing problems. After the stent is in place, the doctor will take out the catheter. The stent will stay in your artery.

The procedure usually takes about 1 to 2 hours. You may need to stay in the hospital for 1 or 2 days after the procedure.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What happens before the procedure?

Having a procedure can be stressful. This information will help you understand what you can expect and how to safely prepare for your procedure.

Preparing for the procedure

• Bring a list of questions to ask your doctors. It is important that you understand exactly what procedure is planned, the risks, benefits, and other options before your procedure.
• Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anesthesia. Your doctor will tell you which medicines to take or stop before your procedure.
• If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your procedure. Make sure that you understand exactly what your doctor wants you to do.
• You may need to stop taking certain medicines a week or more before your procedure, so talk to your doctor as soon as you can.
• Before your procedure, you may speak with an anesthesia provider to discuss your anesthetic options, including the risks, benefits, and alternatives to each. This may be on the phone or in person.

Taking care of yourself before the procedure

• Build healthy habits into your life. Changes are best made several weeks before the procedure, since your body may react to sudden changes in your habits.
  • Stay as active as you can.
  • Eat a healthy diet.
  • Cut back or quit alcohol and tobacco.
• If you have an advance care plan, let your doctor know. If you do not have one, you may want to prepare one so your doctor and loved ones know your health care wishes. Doctors recommend that everyone prepare these papers before a procedure, regardless of the type of procedure or condition.

What happens on the day of the procedure?

• Follow the instructions exactly about when to stop eating and drinking, or your procedure may be cancelled. If your doctor has instructed you to take your medicines on the day of the procedure, please do so using only a sip of water.
• Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Remove all jewellery, piercings, and contact lenses.
• Leave your valuables at home.

At the hospital or surgery centre

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The procedure takes about 1 to 2 hours.
• After the procedure, pressure will be applied to the area where the catheter was put in your blood vessel. Then the area may be covered with a bandage or a compression device. This will prevent bleeding.
• Nurses will check your heart rate and blood pressure. The nurse will also check the catheter site for bleeding.
• You will need to lie still and keep your leg straight for several hours. The nurse may put a weighted bag on your leg to keep it still.
• You may have a bruise or a small lump where the catheter was put in your blood vessel. This is normal and will go away.

Going home

• You will need someone to drive you home.
• For your safety, you should not drive until you are no longer taking pain medicines, and you can move and react easily.
• Arrange for extra help at home after the procedure, especially if you live alone or provide care for another person.
• You will be given more specific instructions about recovering from your procedure, including activity and when you may return to work.

When should you call your doctor?

• You have questions or concerns.
• You don't understand how to prepare for your procedure.
• You become ill before the procedure (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the procedure.