What you can expect

Carotid angioplasty is considered a nonsurgical procedure because it's less invasive than surgery. Your body isn't cut open except for a very small nick in a blood vessel in your groin.

General anesthesia isn't needed, so you're awake during the procedure. You'll receive fluids and medications through an IV catheter to help you relax.

Before the procedure

  • You're taken to an X-ray imaging room and asked to lie on a procedure bed. You'll rest your head in a cup-shaped area to help you remain comfortable and still while pictures of the carotid artery are taken.
  • Your groin is shaved and prepared with antiseptic solution, and a sterile drape is placed over your body.
  • A local anesthetic is injected into your groin to numb the area.
  • Small electrode pads are placed on your chest to monitor your heart rate and rhythm during the procedure.

During the procedure

Once you're sedated, your doctor makes a puncture in an artery, usually the femoral artery in the groin area. The following describes the angioplasty and stenting procedure.

  • A small tube (sheath) is placed into the artery. A catheter with a balloon tip is then threaded through the tube to the narrowing in the carotid artery under X-ray guidance. You won't feel the catheter passing through the arteries because the insides of arteries don't have nerve endings.
  • Contrast material is injected into the carotid artery through the catheter. The contrast material may cause a temporary warm feeling on one side of your face. Contrast material provides a detailed view of the narrowed artery and blood flow to the brain.
  • A filter is placed in the artery. The filter, called an embolic protection device, is inserted beyond the narrowing to catch any debris that may break off from the narrowed area of artery during the procedure.
  • The balloon tip is threaded into the narrowed area and inflated to push the plaque to the side and widen the vessel.
  • A small metal mesh tube (stent) may be placed in the newly opened vessel. The expanded stent provides support that helps prevent the artery from narrowing again.
  • The filter, sheath, catheter and balloon are removed. Pressure is applied to the small catheter insertion site to prevent bleeding.

When the procedure is done, you lie still in one position while pressure is applied to the site to stop bleeding. You generally won't have stitches, but a dressing is applied to cover the small incision site. You'll then be taken to the recovery area.

After the procedure

To avoid bleeding from the catheter insertion site, you need to lie relatively still for several hours. You'll be either in the recovery area or in your hospital room. After the procedure, you may receive an ultrasound of your carotid artery. Most people are discharged from the hospital within 24 hours after the procedure.

The catheter site may remain tender, swollen and bruised for a few days. There may be a small area of discoloration or a small lump in the area of the puncture. You may take acetaminophen (Tylenol, others) in the recommended dose as needed for discomfort, or other medication as prescribed by your doctor.

You may need to avoid strenuous activity and heavy lifting for 24 hours after the procedure.

Nov. 09, 2017
References
  1. Cameron JL, et al. Balloon angioplasty and stents in carotid artery occlusive disease. In: Current Surgical Therapy. 12th ed. Philadelphia, Pa.: Saunders Elsevier; 2017.
  2. Carotid artery disease. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/catd/catd_all.html. Accessed Aug. 29, 2017.
  3. Chaikof EL, et al. General principles of endovascular therapy: Angioplasty, stenting, recanalization, and embolization. In: Atlas of Vascular Surgery and Endovascular Therapy. Philadelphia, Pa.: Saunders Elsevier; 2014.
  4. Mohler ER, et al. Management of symptomatic carotid atherosclerotic disease. https://www.uptodate.com/contents/search. Accessed Aug. 29, 2017.
  5. Angioplasty and vascular stenting. Radiological Society of North America. http://www.radiologyinfo.org/en/info.cfm?pg=angioplasty. Accessed Aug. 29, 2017.
  6. Fairman RM, et al. Carotid artery stenting and its complications. https://www.uptodate.com/contents/search. Accessed Aug. 29, 2017.
  7. Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Sept. 13, 2017.
  8. Cloft H (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 26, 2017.
  9. Jauch EC, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870.

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