Most strokes develop from hardening of the arteries (atherosclerosis) in the frontal neck region, the carotid arteries. These are the pulsatile structures on either side of the neck that carry the majority of blood supply to the brain. Very often, strokes are preventable by cleaning out these arteries surgically. Sometimes, however, patients are not good candidates for the carotid operation, and instead a procedure called stenting is employed.
Patients who are to undergo carotid stenting are brought to the angiography suite in the Radiology Department of the hospital, gently sedated on an x-ray table, and a numbing medicine (local anesthetic) is injected into the groin. A puncture wound is then made, and a catheter is then inserted into the artery in the groin which, with x-ray (flouroscopic) control is passed up into the neck. The blockage in the carotid artery is identified, and a protective filter or umbrella is inserted above the blockage to prevent debris or blood clots from traveling up into the brain. The area of narrowing in the artery is then ballooned open and a metallic mesh stent is placed to maintain patency of the artery and to prevent additional debris from travellng to the brain. These stents are long-lasting, safe, and non-allergenic. The filter and catheter are then removed, and the puncture wound in the groin is sealed to prevent bleeding.
Most patients spend several additional hours in the hospital recovering from the procedure, then go home without significant restrictions or discomfort. All patients are placed on gentle blood-thinners, (some for one month, some for long term) and follow-up is in the office in a week. Ultrasound scans are obtained one month after the procedure, and then at 6-12 month intervals long term to assure that the artery does not narrow due to scar tissue or recurrent atherosclerotic disease.
All patients are further cautioned to follow low fat diets, a graded exercise program and to carefully control other risk factors, such as high blood pressure, high cholesterol, diabetes and exposure to tobacco products.