Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Carotid Artery Stenting
Hardening of the arteries, also known as atherosclerosis, can cause a build-up of plaque. In hardening of the arteries, plaque (a mixture of fat, cholesterol and inflammation) builds up in the walls of your arteries as you age. Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque accumulates, your arteries can narrow and stiffen.
Eventually, enough plaque may build up to reduce blood flow through your arteries, or cause blood clots or pieces of plaque to break free and to block the arteries in the brain beyond the plaque.
When plaque builds up and reduces blood flow in your carotid arteries, you have carotid artery disease. This is a serious issue because clots can form on the plaque and block the blood flow to your brain. If a clot or plaque blocks the blood flow to your brain, it can cause a stroke, which can cause brain damage or death. An ischemic stroke is a stroke that occurs because there is a lack of blood flow to cells in the brain.
Another related problem that the plaque can cause is an arterial embolism. This occurs when a small piece of plaque or a blood clot breaks away from the site where it formed and blocks another artery downstream. If a clot blocks a tiny artery in the brain, it may cause temporary neurological symptoms, called transient ischemic attacks (TIAs), sometimes called "mini-strokes."
Your physician has referred you to our Interventional Radiologists to open a narrowing in your carotid artery. By using a balloon, the blockage can be opened and then kept open by placing a stent across the narrowed segment, which allows the blood to flow smoothly. A stent is a stainless steel wire mesh tube that holds the carotid artery open and keeps it from closing again. It becomes a permanent part of your artery.
How do I prepare for the procedure ?
You will be scheduled for a consultation with the Interventional Radiology Team. Bring a list of questions to ask your doctor. It is important that you understand exactly what procedure is planned, the risks, benefits and other options before your procedure. Generally, you will be given a prescription for Plavix and full strength Aspirin, it is CRITICAL that you take this medication as directed. If you are to undergo General Anesthesia for your procedure we will request that a pre-operative evaluation is done by your Primary Care provider, clearing you for the Carotid Stenting procedure.
What happens during the procedure?
Your vital signs will be monitored by a health care provider throughout the entire procedure (RN or Anesthesiologist). You will have an IV in place and a Foley catheter to empty your bladder. You will also be receiving medication to help you relax. You will lie on your back during the procedure. The technologist will prepare the skin over the groin by cleaning it with an antiseptic solution and place sterile drapes and towels over you to create a sterile work space.
Lidocaine local anesthesia is injected into the skin overlying the common femoral artery in the groin. The Interventional Radiologist will then pass a small catheter (a tiny tube) through an artery in your groin region and then take pictures of the affected blood vessel. If the pictures confirm narrowing of the artery, the Interventional Radiologist then uses a small balloon to open up the narrowed artery and places a stent at the site of the blockage. At the end of the procedure, the catheter is removed and the artery sealed.
What happens after the procedure?
You will be brought to the Intensive Care unit and watched closely by the health care team. In the first 6 hours of recovery, patients are monitored closely for signs of bleeding from the artery in the groin.
Going Home
Since the arterial blood flow is a high pressure system, patients should refrain from lifting more than 10 lbs, refrain from strenuous activity or anything which causes abdominal distension for the following 48-72 hours. Any straining such as vomiting, coughing, forced bowel movements could dislodge the clot that forms to seal the artery and cause bleeding.Do not take a tub bath, go in a hot tub or submerge in water for 5 days. Leave the sterile dressing on for 24 hours, then shower and clean the area daily. Place a clean Band-Aid over the site each day for 5 days. Report any signs of infection (redness, swelling, discharge and fever) to your doctor. At home, you can eat normally, but you should continue drinking extra fluids for 1 to 2 days after your procedure.
What kind of follow-up is needed?
Approximately one to two weeks after procedure we will schedule a baseline carotid ultrasound to evaluate stent patency, as well as an office visit with the Interventional Radiology team.Surveillance imaging and office visits will be required at regular intervals for the life of the stent.
If you have any questions or need to reschedule an appointment please feel free to contact the Interventional Radiology Office at 802- 847-8359. Our business hours are Monday – Friday 8:30 a.m. to 5 p.m. Someone is available to take your call after hours for emergencies.
This information is provided by the Fletcher Allen Health Care, Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.
