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