Generally, carotid artery stenosis is treated with angioplasty and stenting for high-risk patients in many hospitals. It has changed since the FDA has approved the first carotid stent system (Cordis) in July 2004 and the second (Guidant) in August 2004. The system comprises a stent along with an embolic capture device designed to reduce or trap emboli and clot debris. Angioplasty and stenting is increasingly being used to also treat carotid stenosis, with success rates similar to carotid endarterectomy surgery. Simple angioplasty without stenting is falling out of favor in this vascular bed. SAPPHIRE, a large trial comparing carotid endarterectomy and carotid stenting with the Cordis stent found stenting non-inferior to carotid endarterectomy.
What should you expect?
Before the procedure:
- You must not to eat or drink anything after midnight the night before the study except for your normal medications. Your doctor or nurse will tell you if you should stop taking any of your medications prior to the procedure.
- You need to bring a list of all your medications with you to the hospital.
- Please tell the doctor if you think you may be pregnant.
- A nurse will place an IV in your hand or arm so that you can receive fluids and medications.
Your doctor will answer your questions and ask you to sign a consent form
During the procedure:
- You will lie on an x-ray table with machines all around you. You will have a blood pressure cuff on your arm, a clip on your finger to make sure you are getting enough oxygen, and wires on your legs and arms to check your heart rate.
- The nurse will give you pain medication and a sedative, which will help you relax, before the procedure. The nurse will give you more medication if needed. You will feel relaxed, but you will be awake so that you can follow instructions.
- The area where the doctor will be working will be cleaned and shaved. You will be covered with sterile drapes from your shoulders to your feet.
- The doctor will numb the area in the groin or the arm and insert a tiny, flexible tube called a catheter.
- The radiologist will guide the tube in to a large artery in your stomach and inject X-ray dye. The dye may cause a burning feeling in your legs, but it will pass in 20 to 30 seconds. It is important to hold still during this time. You will not feel the tube move inside your artery.
- The technologist will tell you to hold your breath and stay still during the pictures (about 10 seconds for each picture).
After the procedure:
- The radiologist or nurse will remove the catheter and hold the site for 15 to 20 minutes to prevent bleeding. If the catheter was in your groin, you will need to lie flat without raising your leg for about four hours.
- The head of the bed may be tilted a little to help you rest. You will be able to bend the other leg to relieve pressure on your back, or the nurse may roll you on your side. If you develop back pain, the doctor can give you medication to help you feel better. Your nurse will help you with any personal needs.
- Call the nurse right away if you feel any chest discomfort, back pain, or wetness in the area where the catheter was.
- Your nurse will check your blood pressure, heart rate, heart rhythm, and pulse in the area near the catheter insertion.
- You will receive IV fluids to flush the dye from your system.
- You may eat one hour after the procedure if you have had no problem drinking fluids.
- If you need to cough or sneeze, apply pressure to the catheter site first to protect it
- If you are an outpatient, you may leave after a 5 hour recovery period. You will need someone to drive you home.
After you go home:
- You may drive after 24 hours.
- You should avoid strenuous activity or heavy lifting for one week.