Carotid Stenting

Mr. Peter Y. Milne
F.R.A.C.S., F.R.C.S., (ENG), F.A.C.S.

You have been booked for admission to hospital for an operation known as "Carotid Angioplasty and Stenting". This constitutes the the "ballooning open" of the neck artery through a puncture normally in the groin artery. The major aim of Carotid Stenting is to prevent stroke and or blindness by unblocking the neck artery and thus allowing blood to flow unimpeded to the brain.

BEFORE CAROTID STENTING:
You will be admitted to hospital before Carotid Stenting and an Anaesthetist will consult with you regarding sedation. You can ask questions regarding risks of surgery and anaesthesia at this visit. No blood transfusion is required for Carotid Stenting however blood testing may be undertaken to check body function and a Cardiograph is done.

THE PROCEDURE:
Carotid Stenting will last approximately 1-1/2 hours. At completion of the procedure you will have a dressing on the groin puncture and there should be minimal discomfort. Carotid Stenting is usually performed under local anaesthesia although general anaesthetic techniques are sometimes used.

RISKS OF CAROTID STENTING:
Stroke: Although Carotid Stenting is designed to prevent stroke there is a small chance of a stroke occurring during the operation, or in the immediate period after your operation (48Hrs). The chance of this happening with your Carotid Stenting is less than 0.3%.
Heart Attack: The second most major risk associated with Carotid Stenting is one of heart attack and this risk is approximately 0.3%.
Death: Heart attack or stroke during Carotid Stenting is the most common cause of death after surgery and this combined risk is less than 0.6%.

AFTER CAROTID STENTING:
Your post-operative recovery should be rapid and discharge home from hospital can be expected between one and two days after your Carotid Stenting. Following the operation you will be able to get out of bed and move about on the day of surgery. Aspirin is essential as a daily dose of 100-300 mg. after Carotid Stenting to keep the blood less sticky as well as another tablet for 6weeks. Over the next 10 days the groin puncture will be lumpy and tender. Any untoward symptoms such as weaknes or numbness in an arm or leg, vision or speech disturbance, should be reported to Mr. Milne immediately. Other general medical problems (coughs and colds) should, of course, be referred direct to your local doctor.

EXERCISE FOLLOWING CAROTID STENTING:
After your discharge from hospital you may resume most normal activities but heavy exercise should be avoided for approximately seven days after your Carotid Stenting. You may drive a motor vehicle two days following discharge from hospital unless you have any untoward symptoms.

EFFECTIVENESS OF CAROTID STENTING:
Recurrence of the problem of blockage occurs in 3% of patients in the first 18 months after Carotid Stenting. Ultrasound scanning is therefore performed at 6, 12 and 18 month intervals after your operation to detect any abnormal healing. If no narrowing is present after this time then further narrowing from artery hardening is unlikely over the next ten years. Surveillance of the un-operated artery on the other side of the neck artery is advisable and is done by your local doctor or by this practice. If re-narrowing does occur in the first year it is usually managed by balloon treatment.

DISADVANTAGES OF BALLOON/STENT TREATMENT:
There is no long term follow up of the new technology of Carotid Angioplasty and Stenting as yet so it may not be as permanent as surgery for neck artery disease. Although the procedure is now nearly as safe as surgery there is a higher chance of artery blockage and stroke in the first 12 months than after surgery. Surgical management remains the “Gold Standard” of treatment although Carotid Angioplasty and Stenting is getting close to equal efficacy.

© PETER Y. MILNE
F.R.A.C.S., F.R.C.S., (ENG), F.A.C.S.
VASCULAR SURGEON


Mr. Peter Y. Milne, vascular surgeon, vascular surgery. | Transient ischaemic attacks (TIA's), stroke, stroke prevention, carotid endarterectomy, carotid stents, carotid stenting. | Aortic aneurysm, abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), dissecting aortic aneurysm, conventional aortic aneurysm repair, open aortic aneurysm repair, stent grafts, stent grafting, intraluminal grafts, intraluminal grafting, endoluminal grafts, endoluminal grafting | Cardiovascular disease, atherosclerosis, arterial disease, arterial blockage, arterial occlusion, intermittent claudication, diabetes, diabetic foot, ulcers, gangrene, arterial bypass, leg artery bypass, balloon angioplasty | Varicose veins, sclerotherapy, coil occlusion, varicose veins surgery | Hyperhidrosis, chemical sympathectomy.
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