Name of the Procedure:

Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection.

Summary

This procedure involves using a catheter to place a small wire mesh tube (stent) in the carotid artery in the neck (cervical carotid artery) to keep it open. A balloon (angioplasty) may be used to widen the artery, and specialized protection devices are used to prevent clots from moving to the brain during the procedure.

Purpose

Medical Condition:

• Carotid artery stenosis (narrowing of the carotid artery) ##### Goals:
• To restore proper blood flow to the brain
• To reduce the risk of stroke by preventing artery blockage

Indications

• Symptoms of stroke or transient ischemic attack (TIA)
• Significant narrowing of the cervical carotid artery seen on imaging
• High risk for traditional surgical endarterectomy due to other medical conditions

Preparation

• Fasting for 6-8 hours before the procedure
• Adjustment or temporary discontinuation of certain medications, such as blood thinners
• Diagnostic tests: carotid ultrasound, CT angiography, or MR angiography

Procedure Description

1. The patient is given local anesthesia at the catheter insertion site and possibly mild sedation.
2. A small incision is made, usually in the groin.
3. A catheter is inserted and guided through the blood vessels to the carotid artery.
4. Contrast dye is injected to visualize the artery and the narrowing.
5. A balloon catheter may be inflated to widen the artery.
6. A stent is placed to keep the artery open.
7. Distal embolic protection devices (like a small filter) are used to catch any debris during the procedure.
8. The catheter and other devices are removed, and the incision is closed.

Duration

Typically 1 to 2 hours.

Setting

Performed in a hospital setting, usually in a specialized catheterization lab (cath lab).

Personnel

• Interventional radiologist or vascular surgeon
• Registered nurses
• Radiologic technologist
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

Common:

• Bruising or hematoma at the incision site
• Mild bleeding ##### Rare:
• Stroke during or after the procedure
• Artery damage
• Infection at the insertion site
• Allergic reaction to contrast dye

Benefits

• Significantly reduces the risk of stroke
• Minimally invasive compared to open surgery
• Generally quicker recovery time

Recovery

• Monitoring in the hospital for several hours to a day
• Avoid strenuous activities for at least a week
• Follow-up appointments for imaging to ensure the stent is functioning properly
• Lifelong use of anti-platelet medication to prevent clotting

Alternatives

• Carotid endarterectomy: surgical removal of plaque
  • Pros: Direct removal of plaque
  • Cons: More invasive, longer recovery time
• Medical management: medications and lifestyle changes
  • Pros: Non-invasive
  • Cons: May not be sufficient for severe stenosis

Patient Experience

During the procedure, the patient might feel pressure but should not feel pain due to local anesthesia. Post-procedure, there could be mild discomfort at the insertion site, and some patients may experience fatigue. Pain management medications and comfort measures like rest will be provided.