What is carotid artery stenosis?
Internal carotid artery is the major artery supplying the brain. They are two in number and located on either side of the neck. Significant narrowing of the lumen of these arteries due to various causes is known as carotid artery stenosis.
What are the symptoms of carotid artery stenosis?
Significant carotid artery stenosis leads to accumulation of plaque/ clot in the arteries and hence reducing the lumen caliber. These result in decreased blood supply to the brain causing “ stroke” or “TIA (Transient ischemic attacks)”.Symptoms might be varied and include weakness of one side of body, facial weakness, loss of speech, loss of vision etc.
What are the indications of carotid stenting?
Not all patients with carotid stenosis need surgical/endovascular intervention. Common indications include:
- Symptomatic patients: > 50-70% stenosis
- Asymptomatic patients; >70% stenosis and high risk
- Carotid pseudoaneursysm
- Carotid dissection
How is carotid stenting done?
Carotid stenting is minimally invasive surgery/ procedure used to treat critical carotid artery stenosis. Vascular access (tiny hole ~2-3mm) is made through an artery in the thigh (femoral artery).Small catheter is super selectively passed into the diseased carotid artery. Later, balloon angioplasty/ stenting is done depending on the vascular morphology.
(66 year old patient with recurrent stroke; A: critical stenosis (~90%) at the origin of internal carotid artery (red arrow). Mild mucosal irregularity also noted at the proximal ICA; B: Good flow into the internal carotid artery with absent mucosal irregularity (blue arrow) post stenting)
What is duration of hospital stay post carotid stenting?
Usually immediate post stenting, patient is required to be in ICU for ~ 24 hours for monitoring of BP and heart rate. After ICU stay patient is expected to be in the ward for a period of 2-3 days.
What medications are required post stenting?
Patients need to be on dual antiplatelets (oral tablets) post endovascular stenting.
What are the advantages of carotid stenting over surgery?
- Minimally invasive procedure
- No cuts/ scars/sutures.
- Shorter hospital stay (3-4 days)
- Almost nil requirement for blood transfusion
