Your physi­cian has told you that an artery in your neck that sup­plies blood to your brain is too nar­row. Some cho­les­terol plaques are lin­ing the walls of your artery and caus­ing a decrease in the nor­mal blood flow to your brain. This increases your chances of hav­ing a stroke. Your physi­cian has rec­om­mended a pro­ce­dure called angio­plasty and stent­ing to repair that nar­row­ing. Carotid stent­ing is a pro­ce­dure that is used with bal­loon angio­plasty to open up a nar­rowed carotid artery. After place­ment, the carotid stent becomes a per­ma­nent implant to hold the artery open and allow a good blood flow to your brain. The carotid stent is a small, slot­ted stain­less steel tube that comes in dif­fer­ent sizes to match the size of your artery.

PATIENT PREPA­RA­TION

• Do not eat or drink from mid­night on, the day of your procedure.
• A med­ica­tion may be pre­scribed to decrease the risk of blood clots forming.(ex. Aspirin)
• A mem­ber of your fam­ily may accom­pany you.
• When you arrive at the Hos­pi­tal, you will be directed to the Radi­ol­ogy depart­ment where a nurse will take care of you.
• The Neuro-​radiologist and the Anes­thetist will explain the pro­ce­dure to you and ask you to sign the con­sent form.
• A radi­ol­ogy nurse will accom­pany you through­out the procedure.
• An intra­venous will be put in your arm, a car­diac mon­i­tor will be placed, a blood pres­sure cuff put on your arm and a uri­nary catheter inserted.

PRO­CE­DURE

• You will be awake dur­ing the pro­ce­dure so that you can tell us if you feel any­thing wrong (visual prob­lems, weak­ness of extremeties, numb­ness, confusion).
• You have to lie down on your back for at least 2 hours.
• The equip­ment used will be explained to you.
• You will first be given a local anes­thetic in your groin and an intro­ducer (like a small tube) will be inserted into the blood ves­sel. This is the entry for var­i­ous catheters. The first 5 min­utes are uncom­fort­able but after this you will feel only pres­sure in your groin area.
• X-​ray pic­tures of your blood ves­sels will then be done by inject­ing a spe­cial dye through a catheter. You may feel a warm sen­sa­tion when the dye is injected.
• A spe­cial bal­loon catheter is then inserted and inflated at the level of your steno­sis (nar­row­ing of your blood vessel).
• The stent is then threaded to the same level and placed there.
• Another bal­loon catheter opens the stent and push it against the walls of your artery to open the stenosis.
• The bal­loon catheter is removed and another x-​ray pic­ture of your blood ves­sels is done.
• The intro­ducer will remain in your groin for 24 hours.

AFTER THE PROCEDURE

• You will remain in the recov­ery room for about 24 hours with the intro­ducer in your groin. You must not bend your leg, but the head of your bed can be raised up to 30 to 40 degrees.
• When the intro­ducer is removed from your groin, a pres­sure dress­ing is applied for about 12 hours. At this time, we can trans­fer you to your room.
• The intra­venous can be taken out 4 hours later.
• The nurse will check you fre­quently and also check the pres­sure dress­ing for bleed­ing or swelling. The pulse in your foot will be checked to ensure a good cir­cu­la­tion of blood in your leg.
• You must remain in bed for at least 24 hours after the intro­ducer has been removed. How­ever, you can get up to the bath­room after the first 6 hours.
• You can usu­ally go home the next day (48 hours after the procedure).

RETURN HOME

Med­ica­tion:

• It is very impor­tant to take the blood-​thinning med­ica­tion your physi­cian has pre­scribed for you. (Entro­phen (coated Aspirin) and Coumadin). These med­ica­tions pre­vent blood clots from form­ing and attach­ing to your stent.
• If you are pre­scribed Coumadin, you will have to have blood tests to reg­u­late the dosage. You will be given pre­cise instruc­tions to follow.
• This med­ica­tion to thin your blood can make you bleed for longer peri­ods if you hurt your­self or can cause you to bruise eas­ily. Tell your physi­cian if you have any blood in your urine and/​or your stools. Don’t stop tak­ing these med­ica­tions before you check with your physician.

Diet:
Before you will leave the hos­pi­tal, a dieti­cian will meet you and give you a diet low in fat and cho­les­terol. You should fol­low this diet to decrease the risks of atherosclerosis.

Exer­cise:

• Dur­ing the first week, don’t lift heavy objects. The femoral artery needs time to heal well.
• You can walk short dis­tances every day.
• Increase your activ­ity every day and lis­ten to your body for signs of fatigue.
• Your physi­cian will tell you when you may return to work and do your reg­u­lar activities.

Note: You must inform med­ical staff that you have a stain­less steel implant before hav­ing any spe­cial tests. Mag­netic Res­o­nance Imag­ing could move the stent.

Infor­ma­tion about InfoNEURO
Neuro-​Patient Resource Cen­tre
Mon­treal Neu­ro­log­i­cal Hosp­tial Room 354
Tel: (514) 398‑5358
E-​mail: infoneuro@​muhc.​mcgill.​ca
Web site: http://​infoneuro​.mcgill​.ca/

This infor­ma­tion is for edu­ca­tional pur­poses only, and is not intended to replace the advice of a pro­fes­sional health­care prac­ti­tioner, or to sub­sti­tute for med­ical care.

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Neuro-​Radiology Depart­ment of the Mon­treal Neu­ro­log­i­cal Hos­pi­tal. Sept.1998.