About carotid and vertebral stenosis
The carotid and vertebral arteries pass through the neck to supply blood to brain, brainstem and upper spinal cord.
The two carotid arteries are located in the front of the neck on either side of the throat. The vertebral arteries are located further back in the neck and are mostly contained within the bony channels of the cervical spine.
Carotid and vertebral arteries of the head or neck may become narrowed (stenosed) or completely blocked from atherosclerosis. Atherosclerosis is a disease where fatty deposits, called plaque, collect on the inside of the blood vessels. As atherosclerosis progresses, it may cause progressive narrowing of the vessel and reduce blood flow to the brain. It is also possible for pieces of plaque to break off and lodge in smaller blood vessels downstream. This may result in a stroke, or transient ischemic attacks (“miniokes”).
What is Artery Stenting?
By restoring or enhancing blood flow through narrowed carotid or vertebral arteries, the risk of a potentially life-threatening stroke may be reduced or prevented. Surgery to remove the plaque from the artery has been the traditional treatment for restoring blood flow to the carotid arteries. A newer FDA-approved procedure, carotid artery stenting, is a minimally-invasive technique that provides an alternative to surgery. Vertebral artery narrowing cannot be treated surgically and has been effectively treated with stenting for many years.
With stenting, a self-expanding mesh tube is placed within the artery at the site of the narrowing. When placed in the vessel, the outward force of the stent will reduce or completely eliminate the narrowing in the vessel. This technique can be applied to vessel narrowing both in the neck and within the skull.
Carotid and vertebral stents remain permanently in place. They are made of stainless steel or other metal alloys that resist rust. They are not noticed by metal detectors.
Surgery vs. Stenting
Carotid and vertebral artery stenting are much less invasive than surgery. Patients usually have a shorter recovery time. While stenting may be a better option than surgery for many patients, it is not appropriate for all patients. This will be determined by the team of doctors treating you. Some reasons why your doctors may select stenting over surgery are:
You are considered high risk for surgery.
You cannot undergo general anesthesia.
You developed new narrowing in the artery after previous carotid surgery (i.e.:”re-stenosis”).
Risks Involved in Carotid and Vertebral Artery Stenting
There are small risks associated with this procedure. Patients who are deemed suitable for a stent will undergo a comprehensive consultation by an interventional neuroradiologist. A more detailed explanation of the procedure and risks will be provided to the patient during the consultation.
Scheduling, Insurance and Preparation
Consultations for carotid and vertebral artery stenting are done at RIA Neurovascular. The procedure is performed at the following RIA partner hospitals in the Denver, Colorado area:
- Lutheran Medical Center
- Littleton Hospital
- The Medical Center of Aurora
- Sky Ridge Medical Center
- Swedish Medical Center
To schedule a consultation to discuss carotid or vertebral artery stenting, call 720-493-3345.
Carotid and vertebral artery stenting are covered by many insurance carriers, including Medicare and Medicaid under certain conditions. Check with your insurance company to be sure.
Conditions to Let Us Know About
When you have your consultation for a carotid or vertebral artery stenting, let the radiologist or nurse know if any of the following circumstances apply to you:
- Currently pregnant or nursing
- Previous reaction to iodine or contrast material
- Renal disease
- Heart murmur
If you are a candidate for carotid or vertebral artery stenting, you will be given detailed preparation guidelines. Following are some of the basic guidelines; however, you may receive additional or differing guidelines based on your specific situation:
- Do not eat or drink anything but clear liquids for 8 hours before the procedure; do not drink anything for 4 hours before the procedure
- Plavix and aspirin will be prescribed prior to the procedure
- Prepare for an overnight stay in the hospital
- Arrange for someone to drive you home from the procedure
What to expect
Before the procedure
If you appear to be a candidate for carotid or vertebral artery stenting, you will undergo various exams prior to the procedure including cerebral angiography with CT or MRI. These exams will help the interventional neuroradiologist confirm your eligibility for the procedure and plan treatment.
During the Exam
Here is generally what will happen during carotid or vertebral artery stenting:
- You will change into a gown
- A technologist will answer your questions then start an intravenous (IV) line in your arm
- The technologist will set up various devices so your heart rate and blood pressure can be monitored throughout the procedure
- An anesthesiologist will administer intravenous conscious sedation or general anesthesia. If you are given general anesthesia, you will sleep during the procedure
- The site of the groin incision will be cleansed
- A fluoroscope will be moved into position over your mid-section
- The groin incision will be made and the catheter will be inserted into the femoral artery
- Using the fluoroscope images, the radiologist will carefully guide the catheter to the narrowed section of the carotid or vertebral artery
- The radiologist will then guide a stent through the catheter and place it in the narrowed section of the artery. The stent will automatically expand against the vessel walls, reducing or eliminating the narrowing
- The catheter will be withdrawn and the incision cleaned and taped
- The procedure usually takes 1-2 hours to complete, Patients are observed in the Intensive Care Unit overnight following the procedure. Most patients are often discharged the following day
- A fluoroscope, a machine that takes real-time x-rays, is used during stroke therapy to allow the radiologist to see the movement of the catheter within the brain
After the Procedure
After the procedure, you will continue with anti-platelet medication. It will be prescribed by the physician performing the procedure.
Follow-up examinations usually require a CT angiogram (CTA) at approximately 3 months after the initial stenting. Further follow-ups studies may be required, but this will be determined by the treating physician.