Stenting of the carotid artery - a procedure which consists in the installation into the lumen of the vessel narrowed prvolochnoy fine structure in the form of a cylinder, which plays the role of the skeleton - the stent. The stent is usually installed in the pre-expanded artery.
The narrowing of the carotid artery is observed in atherosclerosis - the process of the system, affecting all arteries. The main manifestation of atherosclerosis - the emergence of the inner wall of the artery atherosclerotic plaques. These plaques are composed of cholesterol, calcium and fibrous tissue. Gradually increasing in volume, plaques narrow the lumen of the arteries and interfere with the normal blood flow. When plaques are formed in the lumen of the carotid arteries, cerebral blood flow is disturbed.
Carotid arteries begin from the aortic arch. Around the middle of the neck are divided into external and internal. External carotid arteries supply blood to all the soft tissues of the head. The internal carotid arteries supply blood to the brain.
The appearance of plaques on the walls of the internal carotid artery is fraught with terrible consequences. The plaques are sites of formation of blood clots. This leads to a complete occlusion of the lumen of the arteries. The so-called ischemic stroke. In addition, thrombosis may occur. This condition occurs when an atherosclerotic plaque breaks away from a small blood clot that clogs the arteries of the brain. If you have clogged arteries small caliber developed transient ischemic attack.
There are several types of surgical treatment of carotid artery disease. And one of them is carotid stenting.
Preparation for surgery carotid artery stenting
Typically, preparation for carotid stenting is taking aspirin a week before surgery. This is necessary to reduce blood clotting. Before surgery, the doctor conducting such diagnostic procedures as duplex ultrasound and computed tomography, in addition, if necessary, performed angiography and magnetic resonance angiography. These methods allow us to determine the localization of atherosclerotic plaque. The rate of blood flow through the vessels of the brain, the diameter of their lumen, and other parameters of cerebral circulation.
Are you suitable for carotid stenting?
Currently, surgery carotid stenting for patients at high risk of complications during endarterectomy. The indications for carotid stenting are significant narrowing (60%) of the lumen of the carotid artery, the symptoms microstroke and stroke. If you do not have any symptoms, indications for stenting is a significant narrowing (80%) of the lumen of the carotid arteries and a high risk of complications endarterectomy. In addition, carotid stenting is indicated in patients previously undergone endarterectomy, in relapsed narrowing of the lumen of the arteries.
Carotid stenting is not recommended for:
The presence of cardiac arrhythmias
Allergies to medications used during the procedure
Brain hemorrhage within the previous 2 months
Complete blockage of the carotid artery
Risk factors for complications of carotid stenting
These factors include:
High blood pressure
Allergy to radiopaque agents
Calcification (lime saturation) and a large extent by narrowing the carotid arteries
Sharp bends and other anatomical features that lead to difficulties in setting the stent
Plaque of significant size, or atherosclerosis of the aorta in the beginning of the carotid arteries
Age older than 80 years
Clogging of the arteries accompanying vascular pyr and legs
The procedure of carotid stenting
The operation of stenting is usually performed under local anesthesia. Before the surgery the patient is connected to a special tracking equipment, which controls the parameters such as blood pressure and heart rate.
During surgery, the surgeon is usually talking to the patient, and also gives an indication of the patient periodically squeeze toy or ball to control the function of the brain. Some surgeons perform carotid stenting under general anesthesia.
Before surgery, intravenous heparin to reduce blood clotting. Place anesthetized surgery anesthetic. Before the stenting performed angiography - X-ray method to determine the place of constriction of the vessel. Then the procedure starts with stenting.
Before stenting is usually performed angioplasty. At the same time through the femoral artery of the upper limb or catheter with inflated balloon on the end. The catheter is brought to the site of narrowing the artery, which is controlled in real time x-ray monitor. Further balloon is inflated and the artery expands. If the patient does not feel pain as to the inner wall of blood vessels are no nerve endings. At this stage of the operation the surgeon to place restrictions artery establishes a special container, basket or filter, to prevent embolism (blockage) and stroke, arising from the separation of plaque or blood clots.
After the expansion of the arterial lumen balloon is inflated with stenting performed. For this compressed stent is introduced into the artery through another catheter. Once the stent is in place, extended pre-spray, he relaxes and fulfills the wall of the artery. For a more durable "implantation" of the stent into the artery wall, re-inflated balloon. After that, the catheter device filter is removed. The stent remains in the lumen of the artery. The whole operation takes about 1-2 hours, sometimes longer. Postoperative period after carotid artery stenting
Immediately after surgery, the doctor pulls the catheter position for 15-30 minutes to prevent bleeding. After the surgery recommended to stay in bed for several hours to doctor can monitor the occurrence of complications. It is recommended for a time limit weight lifting. After the surgery is not recommended to take baths (can be shower). Also, the doctor will recommend drinking plenty of fluids to quickly excrete the dye. After surgery, carotid stenting is recommended to take blood thinning (aspirin). In addition, from time to time to carry out control of the carotid arteries using duplex ultrasound scanning. Complications of carotid stenting
The most serious complication of carotid stenting is embolism (blockage) of cerebral vessels, leading to a stroke. Another complication that causes blockage of blood vessels - is thrombus formation along the stent. In addition, a common complication, as restenosis - re-occlusion of the vessel. Another type of complications related to the toxic effect of contrast material in the kidney, especially pronounced in patients with kidney disease. Less common hematoma or false aneurysm of the catheter.
