Carotid & Vertebral Artery Stenting

Illustration of the carotid and vertebral arteriesThe carotid and vertebral arteries pass through the neck to supply blood to the head and brain. The two carotid arteries are located in the front of the neck on either side of the throat. These arteries supply blood to the face and cerebrum. The vertebral arteries are two smaller arteries that pass through the spine into the brain. They primarily supply blood to the brain stem.

Carotid and vertebral arteries may become blocked from atherosclerosis, a disease where fatty deposits, called plaque, collect on the inside of the blood vessels. As the fatty deposits grow, they restrict blood flow and may prevent organs and tissues from receiving enough blood and oxygen. It is also possible for pieces of plaque to break off and lodge in smaller blood vessels downstream. When atherosclerosis occurs in the carotid or vertebral arteries, the result may be a stroke, transient ischemic attacks (“mini-strokes”), or vertebrobasilar insufficiency, a condition which causes unsteadiness, weakness, and visual changes.

By restoring blood flow through the carotid or vertebral arteries, a potentially life-threatening stroke may be 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 can not be treated surgically and has been effectively treated with endovascular stenting for many years. With stenting, a mesh tube is placed within the artery at the site of the plaque buildup. The stent is deployed to exert pressure on the artery wall to keep it open, thereby restoring blood flow.

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.

This page contains the following information about carotid and vertebral artery stenting:

Reasons for Having Carotid or Vertebral Artery Stenting

Carotid and vertebral artery stenting are much less invasive than surgery and lower cost. They also have a shorter recover time. However, they are not appropriate for all patients. Carotid or vertebral stenting may be a better option for you than surgery if any of the following circumstances apply:

Risks Involved in Carotid & Vertebral Artery Stenting

There are some risks associated with this procedure.

Since a catheter is placed within the blood vessels, there is a risk of damage to a blood vessel, bruising or bleeding at the puncture site, or infection.

You could have an allergic reaction to the contrast material used during the procedure, although this is rare.

There is a risk of stroke; however, this is minimized by the use of a distal embolic protection device. This device acts as a net to trap pieces of plaque that dislodge during the procedure and prevent them from catching in smaller vessels in the brain.

Blood clots may form around the stent. You will take medication and aspirin for 3 months following the procedure to reduce this risk.

Plaque may build up around the stent, causing restenosis and requiring additional treatment.

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Conditions to Let Our Doctor Know About

In advance of your exam, let your Invision Sally Jobe radiologist or technologist know if any of the following circumstances apply to you.

Insurance Coverage for Carotid & Vertebral Artery Stenting

Carotid and vertebral artery stenting are covered by many insurance carriers, including Medicare and Medicaid under certain conditions. Check with your insurance carrier to be sure.

Procedure Locations

Carotid and vertebral artery stenting are performed by Invision Sally Jobe radiologists at the following Invision Sally Jobe partner hospitals in the Denver, Colorado area:

Consultations for carotid and vertebral artery stenting are done at RIA Endovascular.

Please note:

Invision Sally Jobe is partially owned by Radiology Imaging Associates (RIA); consequently, your radiologist’s lab coat and your bill, if you receive one, will say RIA rather than Invision Sally Jobe.

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Scheduling a Carotid or Vertebral Artery Stenting

To schedule a consultation for a carotid or vertebral artery stenting, call 720-493-3406.

Preparing for a Carotid or Vertebral Artery Stenting

Following are the general preparation guidelines for carotid and vertebral artery stenting. You may receive additional or differing guidelines based on your specific situation. Please contact us at 720-493-3406 if you have any questions.

What to Expect During the Procedure

If you appear to be a candidate for carotid or vertebral artery stenting, you will undergo various exams including a CT angiography or MR angiography. These exams will help the radiologist confirm your eligibility for the procedure and plan treatment.

When you come in for the procedure, you will be asked to change into a gown. After answering any questions you have, a technologist will start an intravenous (IV) line in your arm. He or she will set up various devices so your heart rate and blood pressure can be monitored throughout the procedure. You will be given medications through the IV to prevent blood clots and protect your heart.

An anesthesiologist will administer either intravenous conscious sedation or general anesthesia for the procedure.

A fluoroscope is used during carotid and vertebral artery stenting to allow the radiologist to see the movement of the catheter within the body. The fluoroscope will be moved into position over your abdomen.

After injecting local anesthetic and making a small incision at the groin, the radiologist will thread a catheter into the femoral artery. While watching the fluoroscope images on a computer screen, the radiologist will maneuver the catheter through the arteries to the narrowed carotid or vertebral artery. Through the catheter, the radiologist will deploy a distal embolic protection device past the site of the plaque buildup to catch any plaque that dislodges during the procedure. He may then perform angioplasty by guiding a small balloon to the site of the narrowing. The balloon will be inflated then deflated and removed through the catheter. The radiologist will then guide a compressed stent through the catheter and release it in the same area. The stent will automatically expand against the vessel walls. The radiologist may also deploy and inflate another balloon within the stent to further expand it.

While you may feel some pressure or discomfort during the procedure, you should not feel any pain. If you do experience any pain, let your radiologist know right away.

After the stent is securely in place, the distal embolic protection device will be closed and removed through the catheter. The catheter will then be withdrawn and the incision cleaned and taped.

The procedure usually takes 1-2 hours to complete. After the procedure, the site of the incision will be compressed for 20 minutes and you will need to lie in bed for 5 or 6 hours. You will remain in the hospital overnight for observation.

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Recovering from Your Procedure

After leaving the hospital, you should avoid strenuous activity for 24 hours. You may then resume your normal activities. You must continue to take Plavix and aspirin every day for 3 months after the procedure.

Additional Information

The information on this page was taken in part from the following web sites. Visit these sites for additional information on carotid and vertebral artery stenting.

Sources

CT angiography of the carotid and vertebral arteries 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.