Carotid Angioplasty/ Stenting - Dr. Vikas Gupta

A disease that affects the blood vessels leading to the head and brain is called a Carotid artery disease. Just the same way as heart, the brain’s cells are in a need of constant supply of oxygen-rich blood, which is also known as Oxygenated blood. Two large carotid arteries in the front of your neck and by 2 smaller vertebral arteries at the back of your neck help to meet this blood supply to the brain. At the base of the brain to form what is called the basilar artery the right and left vertebral arteries come together. When the carotid arteries become blocked and the brain does not get enough oxygen a stroke most often occurs.

The risk of stroke is increased because Carotid artery disease in 3 ways:

• Because of fatty deposits that are called plaque. These severely narrow the carotid arteries.

• Because of a blood clot that has become wedged in a carotid artery, that has been narrowed by plaque.

• When plaque breaks off from the carotid arteries and blocks a smaller artery also known as the cerebral artery in the brain

Carotid artery angioplasty is done either by Interventional neurosurgeon or endovascular surgeons in order to open the clogged arteries in the patient’s neck to prevent or to treat a stroke. A long, thin tube called a catheter that has a small balloon on its tip is used. The balloon is inflated at the blockage site in the carotid artery so that the plaque can be flattened or compressed against the artery wall.

With the placement of a small, metal, mesh-like device called a stent carotid angioplasty is often combined. When placed inside of a carotid artery, a stent acts as a support. So that the artery remains the artery opened. Therefore the stent helps to improve blood flow to the brain by keeping the carotid artery open. Vascular stenting are minimally invasive procedures performed to improve blood flow in the body’s arteries.

To perform an angioplasty, an interventional neurosurgeon makes a small nick in the skin and inserts a balloon-tipped catheter, a thin, plastic tube. The catheter is threaded through the artery until it reaches the site of the blockage, where the balloon is inflated, then deflated and removed. Expanding the balloon helps to restore blood flow by stretching the arterial wall, which increases the inner diameter of the artery.

Many angioplasty procedures also include the placement of a stent, a small, flexible tube made of metal to support the damaged artery walls. Stents are typically placed over a balloon-tipped catheter, which is expanded, pushing the stent in place against the artery wall. When the balloon is deflated and removed, the stent remains permanently in place, acting like a scaffold for the artery.

Angioplasty is used to treat when arteries all over the body have narrowed or blocked, including:

• Peripheral vascular disease which is the narrowing of the arteries in the legs or arms.

• When a person’s neck arteries which are supplying blood to the brain get narrowed.

• If a person has carotid artery with 70 percent or more of blockage , especially if the person has had a stroke or stroke symptoms, and he isn’t healthy enough to undergo surgery

• If a person has already had a carotid endarterectomy and is experiencing new narrowing after surgery

• If the location of the narrowing is difficult to access with endarterectomy for the surgeons

• If the large arteries have been narrowed because of atherosclerosis, or because of hardening of the arteries which is a process in which cholesterol and other fatty deposits, called plaques, gradually build up on the artery walls.

• peripheral artery disease (PAD), a narrowing of the arteries in the legs or arms. In patients with PAD, angioplasty alone or angioplasty with stenting may be used to open up a blocked artery in the pelvis, leg or arm.