Carotid arteries are a pair of large blood vessels present on either side of the neck that supply blood to the brain. When these arteries get blocked, it leads to a condition known as carotid artery disease. In this disease, the arteries become narrow due to atherosclerosis in which plaque, made up of cholesterol and calcium, deposits on the inner lining of these arteries causing the arteries to harden and narrow. Due to the presence of plaque the blood flow is restricted and oxygen supply to the brain cells is reduced.
Narrowing of the arteries may cause symptoms such as stroke and Transient Ischaemic attacks (TIA). Narrowing of the arteries may also cause no symptoms, but may then suddenly present with severe acute stroke.
Indications and Investigations
Carotid angioplasty and stenting (CAS) is an alternative surgical procedure performed in some patients where carotid endarterectomy cannot be performed. This includes patients with a significant risk of death from the procedure such as patients with advanced heart disease and patients with a previous neck surgery. In cancer patients undergoing radiation therapy of the neck, CAS is preferred over carotid endarterectomy.
Preparing for Surgery
Before undergoing surgery, inform your doctor about any medications or supplements you are taking. You may need to discontinue certain medications. Also, inform your doctor about any existing medical conditions or illness. Avoid oral intake of any food or drink, including water, for about 9 to12 hours before your surgery. Your prescribed medications can be taken along with a small sip of water.
CAS is a relatively less invasive procedure where a catheter is introduced into an artery through a small incision over the groin and is gradually advanced towards the blockage in the carotid, under fluoroscopic guidance. A tiny balloon is guided to the area of the blockage and inflated to widen the artery and increase blood flow. Carotid angioplasty is often combined with the placement of a stent, a tiny mesh tube, which is left inside the artery. This widens the artery and restores the blood supply to the brain. The stent helps maintain the patency of the artery and prevents it from future narrowing.
After the surgery, you will be kept in hospital for observations. You will be given blood thinning medications to prevent blood clot formation.
Risks and complications of CAS includes, embolic stroke due to accidental release of plaque fragments during the procedure, blood clots and heart attack. A small risk of seizures and strokes also exists. The procedure is only recommended when the benefits will clearly outweigh the risks of the procedure.