Carotid Stenting Surgery: An Overview

Carotid stenting is a procedure including minimally invasive processes that assist in the treatment of carotid artery disease (CAD) that involves narrowing of the carotid arteries due to the development of plaque. The brain receives its blood supply from these arteries on either side of the neck. These blockages in the arteries increase the risk of stroke. It is the placement of a stent, a small mesh-like tube, in the artery to keep it open and restore normal blood flow outside walls. This maneuver is an attractive alternative to carotid endarterectomy, which is an extensive surgical procedure.

Types of Carotid Stenting

We classify the various carotid stenting types according to the different techniques and materials used:

1. Balloon-Expandable Stent—This stent expands with the help of an inflatable balloon to open an artery.

2. Self-Expanding Stent—This stent is flexible and will expand once deployed.

3. Closed-Cell Stent: This offers more scaffolding and support, but it also reduces flexibility.

4. Open-Cell Stent—These stents offer more flexibility but, with a slight decrease, in plaque coverage.

5. Covered Stents—Use covered stents when extra plaque stabilization is required.

Symptoms

Carotid artery disease does not commonly present symptoms until the disease is serious. Thus, worsening disease will manifest itself with the following symptoms:

• Mini-stroke, also known as transient ischemic attack (TIA)

• Sudden numbness or weakness in the face or limbs, usually occurring on only one side of the body

• Difficulty in speaking or comprehending speech

• Double or loss of vision in one eye

• Loss of balance due to dizziness

• Sudden, severe headache

Diagnosis

This involves a panel of imaging studies and other diagnostic tests, for instance:

1. Carotid Ultrasound: This technique uses sound waves to create images of the blood circulation and identify blood vessel blockages.

2. CT Angiography (CTA)—Using X-ray light and dye contrast, it provides a detailed snapshot of blood vessels.

3. Magnetic Resonance Angiography (MRA)—Magnetic resonance provides an anamorphosis of blood vessels.

4. Carotid Angiography: This invasive procedure uses contrast beams to outline the blood vessels.

5. Physical Examination/History—We seek details about potential risk factors, such as high blood pressure, cholesterol, and smoking.

Risks and Complications

There are always some known risks that may prevent the success of carotid stenting. Some of these factors place sensitive portions of the patient at substantial risk:

• Stroke during or postoperative

• Bleeding site in the catheter insertion

• Possible stent occlusion by a formation of blood clots

• Rebuild of the artery walls (unfortunately labeled restenosis)

• Allergic reactions to contrast dye and contrast material

• Some pre-existing kidney conditions may suffer from kidney damage.

• Swelling or bruising at the site of incision in the groin area.

Causes

There are several known causes of carotid artery blockage;

• Atherosclerosis—where blood vessels become compromised and clear away any plaque.

• Hypertension—continuous high blood pressure puts extra pressure on both walls.

• Smoking—This activity damages blood channels and hastens the formation of a plaque along the vascular inlet.

• Diabetes—the syndrome tends to produce higher levels of cholesterol and damage blood vessels.

• Hypercholesterolemia—a surge of cholesterol accrued in the arterial wall.

• Obesity—This relegating class of individuals wrestles with multiple risk factors, such as high BP and diabetes.

• Lack of daily exercise—This emphatically establishes cardiovascular weakening and plaque formation.

Preparation

Procedure preparation includes:

• Pre-operative Tests—These may include blood tests, electrocardiogram (ECG), and imaging studies to evaluate the degree of artery blockage.

• Drug Management: Stop using relevant blood thinners.

• Changes in Lifestyle—The patient should stop smoking, minimize alcohol consumption, and be well hydrated.

• Fasting—The patient should fast for a few hours before getting into the procedure.

• Preoperative hydration and rest so the body is in the best possible condition for surgery.

Procedure

The carotid stenting surgery essentially includes the following steps:

1. Anesthesia—Most of anesthesia is carried out under local anesthesia with some degree of mild sedation.

2. Catheter Placement—We make an incision at the femoral artery site and insert a catheter there.

3. Catheter Navigation: The catheter is directed using fluoroscopy to the carotid artery location.

4. Balloon Angioplasty: After exposing the mal-to-carotid artery, an inflated balloon enlarges it.

5. A Wire Mesh Tube Is Inserted: Stent: In positioning the stent to maintain artery openness.

6. Catheter Removal—Close the incision after removing the catheter.

7. Post-operative Monitoring—Keep a close watch for any possible complications in the patient.

Recovery

Completing recovery primarily comprises the following:

• Hospital Stay—After carotid stenting, the patient typically undergoes 24-48 hours of monitoring.

• Pain Management—Although not particularly severe, the catheter disposition can cause pain that should be mitigated using pain relief medications.

• Activity Restrictions: Avoid engaging in any strenuous exercise for at least a week.

• Appointments in Connection with Follow-Up—The stent's purpose and the health of the patients' carotid arteries should be monitored regularly.

• Efforts Toward Long-Term Lifestyle Changes—People may follow a healthy diet as well as exercise combined with quitting smoking.

Clinical Trials

Currently, clinical trials are focused on:

• Inventive Stent Technologies—Inventing more enhanced stents to lower the risk of restenosis.

• Alternative Approaches—Investigating hybrid techniques that include an endarterectomy plus stenting.

• Ongoing Medications Trials—To determine new antiplatelet drugs to decrease the rate of complications post-stenting.

• Long-Term Outcomes—Observing patient behavior for years.

Side effects

There are some side effects of the surgery, which are as follows:

• Mild headache or slight dizziness

• Mild bruise on the catheter site

• Pain or swelling in the groin

• Temporary speech or temporary vision loss

• Unusual fatigue that could last for a few days

Success Rate

The basic success rate of carotid stenting would differ with surgical expertise and patient factors such as:

• Immediate Stroke Prevention: More than 90% effective after approximately 6 months, meaning that fewer future strokes will occur.

• Restenosis Risk: Up to 5-10% could suffer repeat carotid artery narrowing post-stenting procedure.

• Long-Term Benefits: Many patients will go on to have improved blood flow of the carotid arteries for years after the carotid stenting procedure.

Diet to follow after treatment

After carotid stenting, maintaining a healthy diet is crucial for the patient.

• Fruits and Vegetables—High in antioxidants and fiber.

• Low Fat and Lean Protein—This could be one from white meat, poultry, fish, and all types of plant proteins.

• Whole Grain Foods—Especially, they shall include brown rice, quinoa, whole grain corn tortillas, and whole wheat pasta.

• Healthy Fats—So include your food plan for such things as olive oil, avocados, and nuts.

• Low Sodium—To such an extent that it restricts the establishment or maintenance of forthcoming peaks in blood levels.

• Water: Maintaining the health of the arteries requires adequate water.

Cost of Carotid Stenting in India

It normally depends upon the location of the hospital where the surgery is performed and the expertise of the surgeon involved:

• Price: ₹250,000 - ₹500,000

• Cost of Tests: ₹10,000 - ₹30,000

• Charges for the hospital stay and drug costs: ₹50,000-₹150,000

• Estimated Cost: ₹300,000 - ₹700,000

Conclusion

Carotid stenting is an extremely effective method of preventing carotid artery disease-related strokes. Advances in medical technology have improved the procedure, leading to fewer complications, strokes, and death rates. A healthy lifestyle, following a procedure, significantly improves long-term results.