On the day prior to your treatment you may be asked to withhold some of your blood pressure medication so as not to interfere with the blood pressure response during the actual stent procedure.
On the morning of the stent procedure, make sure you take aspirin and other blood thinning medication. Tell your doctor about any allergies you have, especially to contrast dye or iodine. Tell your doctor if you cannot take aspirin, since aspirin and other medications are usually begun prior to a procedure and continued for several months afterwards. Blood pressure medicines should be withheld the morning of the procedure. Do not eat any solid food on the morning of the procedure.
Medications and Risk Factor Changes
Medications typically prescribed include aspirin, Plavix®, Coumadin® (also known as Warfarin), or Ticlid®. These medications lower the risk of blood clots. In addition, your doctor may prescribe medications to manage your blood pressure or cholesterol.
During Your Procedure
Once you are in the angiographic suite, you will be moved onto an x-ray table. The procedure will be done through an artery in your leg or arm, so your groin area or the arm will be washed with an antibiotic solution and then covered with a sterile sheet. Your doctor will inject a local anesthetic (numbing medicine) into the area where the catheters will be inserted. You may feel a sting when the needle is put into your groin and a brief warm sensation when the medicine is injected.
Next, your doctor will insert the guiding catheter into your artery. Your doctor will inject contrast (x-ray dye) into the guiding catheter to allow him to see the arteries in your neck and brain. Your face and neck may feel warm or flushed when this happens, but this usually goes away after a short time.
Your doctor will pass the Embolic Protection System into the carotid artery to help capture any plaque or particles that could travel into the smaller vessels in the brain. You should not feel any discomfort during this part of the procedure.
Your doctor will insert the Carotid Stent System through the vessels to the area of the plaque. After careful positioning, your doctor will open the stent to cover the plaque.
Your doctor will insert a balloon catheter into the carotid stent to open it wider. The stent will remain in place permanently, but the balloon will be removed. He will then remove the Embolic Protection System and all other devices from your body.
Following the Procedure
You will be taken to a special observation unit where nurses and physician will monitor your condition closely. Your vital signs (heart rate and blood pressure) and the area in which the catheter was inserted will be checked frequently. In addition, your neurological status will be checked by your nurse who will ask you questions, instruct you to move your fingers and toes, and check your pupils with a flashlight. Your blood pressure and puncture site will also be closely watched. Your doctor may use a special vascular closure device to close the small incision in your groin.
It is possible that you may be on special intravenous medications that require closer observation in an Intensive Care Unit for one night for you safety. Otherwise normally, you will spend one night in our monitored unit.
While you are in the hospital, you should let us know if you have any dizziness, severe headache, sudden numbness in your legs, arms or just one side of your body, sudden weakness, blurred vision, blindness in one or both eyes, difficult swallowing or speaking, or pain at the puncture site in your groin.
After the Carotid Stent Procedure
You may need to stay in the hospital for one or two days. Before you leave the hospital, your doctor will give you guidelines for activities, diet, and medications. We will also give you your Stent Implant Card which has important information regarding your Carotid Stent.
After you are discharged, be sure to call us immediately if you have any new symptoms or worsening of the symptoms you had before the stent placement, such as:
- Severe headache
- Slurred speech
- Problems at your puncture site such as increasing swelling, pain or bleeding
- Weakness or numbness affecting one side of your body (for instance, your right arm, leg, or face becomes weaker than your left)
- Blurry vision or sudden loss of vision, one or both eyes
Because medications will be an important part of your treatment, your doctor will prescribe many to take at home. It is important to follow your medication regimen exactly. These medications will help prevent blood clots from forming in the newly opened carotid artery. Notify us if your medications cause unpleasant reactions, but do not stop taking them unless instructed to do so. Your doctor may be able to prescribe new medications that better suit you. It is important to keep all scheduled follow-up appointments.
There is always a chance of complications from any procedure. These include: allergic reactions, bleeding, heart attack, stroke or TIAs, even death, damage to your blood vessels, emboli, blood clots or re-narrowing blocking blood flow through the stent, infection or bruising of your groin area at the catheter insertion site.
Note: Many times we prescribe combinations of antiplatelets and anticoagulants to decrease the risk of forming a blood clot in your artery. If your pharmacist tells you that the medications cannot be taken as your doctor ordered, please contact him at the office.
Your Stent Implant Card
Tell any dentist or doctor who treats you for any reason that you have a stent implant in your neck, and keep your Stent Implant Card with you at all times. Your Stent Implant Card identifies the doctor who implanted your stent and how to reach us, the hospital where you received your Carotid Stent, the date it was implanted, and where it was placed in your carotid artery. It also identifies important information about your stent, such as the size of the stent and the date the stent was manufactured. The card gives your doctor valuable information that is necessary if you need an MRI or MRA. There are also phone numbers on the card that your doctor can call if he/she has any questions.