San Diego, California - Carotid angioplasty is a procedure that opens clogged arteries to prevent or treat stroke. The carotid arteries are located on each side of your neck and are the main arteries supplying blood to your brain. The procedure involves temporarily inserting and inflating a tiny balloon where your carotid artery is clogged to widen the artery.
Carotid angioplasty is often combined with the placement of a small metal coil called a stent in the clogged artery. The stent helps prop the artery open and decreases the chance of it narrowing again. Carotid angioplasty and stenting may be used when traditional carotid surgery isn't feasible or is too risky.
Carotid angioplasty and stenting may be an appropriate stroke treatment or stroke prevention option if:
- You have a carotid artery with a 70 percent blockage or more, especially if you've had a stroke or stroke symptoms, and you aren't in good enough health to undergo surgery — for example, if you have severe heart or lung disease or had radiation for neck tumors
- You've already had a carotid endarterectomy and are experiencing new narrowing after surgery (restenosis)
- The location of the narrowing (stenosis) is difficult to access with endarterectomy
In some cases, traditional carotid surgery (carotid endarterectomy) may be advised to remove the buildup of plaques (fatty material) that is narrowing the artery. In other cases, angioplasty and stenting may be a better option.
As with any surgical procedure, complications may occur. The following are some of the complications that may be associated with carotid angioplasty and stenting:
Stroke or ministroke (transient ischemic attack, or TIA). During angioplasty, blood clots that may form on the catheters can break loose and travel to your brain. Blood thinners are given during the procedure to reduce this risk.
A stroke can also occur if plaques in your artery are dislodged when the catheters are being threaded through the blood vessels.
- New narrowing of the carotid artery (restenosis). A major drawback of carotid angioplasty is the chance that your artery will re-narrow within months of the procedure. Stents have been developed to reduce the risk of restenosis.
- Blood clots. Blood clots can form within stents even weeks or months after angioplasty. These clots may cause a stroke or death. It's important to take aspirin, clopidogrel (Plavix) and other medications exactly as prescribed to decrease the chance of clots forming in your stent.
- Bleeding. You may have bleeding at the site in your leg where catheters were inserted. Usually this simply results in a bruise, but sometimes serious bleeding occurs and may require a blood transfusion or surgical procedures.
Before a scheduled angioplasty, your doctor reviews your medical history and performs a physical exam. You may also have one or more of the following examinations before an angioplasty and stenting procedure:
- Ultrasound. A scanner is passed over the carotid artery to produce images (using sound waves) of the narrowed artery and of the blood flow to the brain.
- Magnetic resonance angiography (MRA) or computerized tomography angiography (CTA). These exams provide highly detailed images of blood vessels by using either radiofrequency waves in a magnetic field or by using X-rays with contrast material.
- Carotid angiography. During this exam, contrast material (visible on X-rays) is injected into an artery so that vessels can be seen and examined.
You'll receive instructions on what you can or can't eat or drink before angioplasty. Your preparation may be different if you're already staying at the hospital before your procedure.
The night before your procedure:
- Follow your doctor's instructions about adjusting your current medications. Your doctor may instruct you to stop taking certain medications before angioplasty, particularly if you take certain diabetes medications or blood thinners.
- Take approved medications with only small sips of water.
- Arrange for transportation home. Angioplasty usually requires an overnight hospital stay, and you won't be able to drive yourself home the next day because of lingering effects of the sedative.