Carotid angioplasty is basically a surgical procedure which is designed to open clogged arteries so as to treat or prevent strokes. Carotid arteries are located on either sides of the neck & are the main arteries which supply blood to the brain. In order to widen clogged arteries, this procedure temporarily involves inserting & inflating a tiny balloon at the site where carotid artery requires treatment. Most often, carotid angioplasty is combined with placement of small metal coils known as stents within the clogged arteries. These stents help prop open the carotid artery & thereby decrease chances of arteries narrowing once again. Carotid angioplasty & stent placement may be ideally used for patients where traditional carotid surgery is either too risky or not feasible.
Why Undergo Carotid Angioplasty?
Carotid angioplasty & stent placement procedure may be an appropriate solution for treatment & prevention of strokes in the following conditions.
- Patient is having 70 percent blockage or more in the carotid artery. This is especially true in case they have had a stroke or symptoms of stroke & are in good overall health so as to undergo surgery. For example, this is a good medical solution for patients who are having severe heart or lung disease, or have undergone विकिरण चिकित्सा for neck tumors.
- Patients who have already undergone carotid endarterectomy & are now experiencing newer narrowing (restenosis) following surgery.
- Ideal for patients where stenosis (narrowing) in carotid artery is difficult to access with endarterectomy procedure.
However, in some cases of carotid endarterectomy or traditional carotid surgery doctors may advise removal of buildup of fatty material (plaques) which is narrowing the artery. But then, in most other cases carotid angioplasty & stent placement may be the better option.
Risks & Complications of Carotid Angioplasty
Like with other types of surgical procedures, complications are also found to occur with carotid angioplasty. Following is a list of some common types of complications which are associated with carotid angioplasty & stent placement.
- Stroke or Ministroke or Transient Ischemic Attack (TIA) – Blood clots which can form on catheters can break loose & travel to the patient’s brain during carotid angioplasty. Therefore, blood thinners are invariably given to patients during this procedure in order to reduce these risks. Strokes can also occur when plaques in the artery get dislodged when catheters are being threaded through blood vessels.
- Restenosis – New Narrowing of Carotid Artery – Major drawback of carotid angioplasty procedure is the chance that the patient’s artery may re-narrow within months following this procedure. This is the reason why stents have been developed so as to reduce risk of restenosis in carotid angioplasty patients.
- खून बह रहा है - Carotid angioplasty patients may bleed at the incision site in the leg where catheter is inserted. Most often, this simply results in a bruise, but at times it can result in serious bleeding & may require additional surgical procedures or a blood transfusion.
- रक्त के थक्के - Blood clots are also found to form at times within stents either weeks or months after carotid angioplasty procedure. These blood clots may in some cases cause stroke or even death. It is therefore important for patients to take aspirin, clopidogrel (Plavix) or some other medication as prescribed by the cardiac surgeon so as to decrease chances of blood clot formation within the stent.
Preparing for Carotid Angioplasty
Doctors will review the patient’s medical history & perform a physical examination before a scheduled carotid angioplasty procedure. Patients may also have to undergo one or more of the following examinations before going in for carotid angioplasty & stent placement procedure.
- अल्ट्रासाउंड – Scanner is passed over carotid artery in this examination in order to produce images using sound waves of the narrowed carotid artery & of blood flow to the brain.
- MRA – Magnetic Resonance Angiography or CTA – Computerized Tomography Angiography – These examinations are able to provide highly detailed images of blood vessels, either by using radiofrequency waves within a magnetic field or by using X-rays along with contrast material.
- Carotid Angiography – During this examination a contrast material which is visible on X-rays is injected into carotid artery so that these blood vessels can be seen & examined.
Patients will receive instructions from the healthcare team as to what can or cannot be eaten or drunk prior to carotid angioplasty procedure. Preparation of patients for this procedure may differ in case they are already staying at the hospital facility prior to the carotid angioplasty procedure.
On the Night before Undergoing Carotid Angioplasty Procedure
- Follow Doctor’s Instructions about Adjusting Current Medications – Doctors often instruct patients to stop taking certain medications prior to undergoing carotid angioplasty. This is particularly so when patients are taking certain blood thinners & diabetes medications.
- Take Approved Medications with Small Sips of Water – Since it is advised not to drink anything including water on the night before undergoing carotid angioplasty, patients must therefore take approved medications only with small sips of water.
- Arrange for Transport Back Home Following Carotid Angioplasty – Carotid angioplasty usually requires just an overnight stay at the hospital. Patients must therefore arrange for someone to drive them back home since they will not be able to drive the next day because of lingering effects of sedatives.
Carotid Angioplasty Procedure
Carotid angioplasty procedure is often considered a nonsurgical treatment procedure since it is less invasive than the traditional method of surgery. Carotid angioplasty does not cut open except for a very small cut in blood vessel in the groin region. Moreover, general anesthesia is also not required & therefore patients will remain awake during this procedure. However, they will receive fluids & medications through an intravenous (IV) catheter so as to help relaxation.
Just Before Carotid Angioplasty Procedure
- Patients will be taken to an X-ray room before the procedure & be asked to lid down on the procedure table. They will be made to rest their head in a cup-shaped area in order to help them remain still & comfortable while pictures of carotid arteries are taken.
- Groin area is subsequently shaved & prepared with an antiseptic solution. A sterile drape is also placed over the body of the patient.
- Local anesthetic is then injected into the groin region so as to numb the area for a small incision.
- Small electrode pads are placed on chest in order to moderate heart rate & rhythm during the carotid angioplasty procedure.
During the Carotid Angioplasty Surgery Procedure
Surgeons will make a puncture in an artery, which is usually the femoral artery in the groin area, after the patient is sedated. Following steps effectively describe the carotid angioplasty & stent placement procedure.
- Small Tube (Sheath) Placement into the Artery – Catheter is then inserted into the artery & threaded through the tube to the narrowing within the carotid artery under the guidance of X-ray imaging. Patients will not be able to feel the catheter passing through the arteries because inside lining of arteries do not have any nerve endings.
- Injection of Contrast Material into Carotid Artery through a Catheter – Contrast material can cause a warm feeling on one side of the patient’s face & which is temporary in nature. Contrast material is meant to provide detailed vies of narrowed arteries & effective blood flow to the brain region.
- Umbrella-Shaped Filter Placement – This filter is an embolic protection device which is inserted beyond the narrowed carotid artery area & is meant to catch any debris which may break away from the narrowed operating area of the carotid artery during the procedure.
- Insertion of Balloon into Narrowed Area of Carotid Artery – Inserted balloon is threaded to the narrowed carotid artery operating site & inflated so as to push plaques to the side & widening of the blood vessel.
- Stent Placement – Small Metal Mesh Tube in Newly Opened Blood Vessel – Expanded stent at the newly opened carotid artery operation site will serve as a scaffold which will eventually help prevent the carotid artery from narrowing once again.
- Removal of Filter, Sheath & Catheter – Pressure is subsequently applied to the small catheter insertion site in the groin region so as to prevent bleeding. When the procedure is completed, the patient will lie still in one position while pressure is applied to the incision site so as to stop bleeding. Finally the patient will be moved to a recovery area for monitoring.
After the Carotid Angioplasty Procedure
In order to avoid bleeding from the incision site through which the catheter is inserted, patients will need to lie down relatively still for several hours, either in the hospital room or the recovery area. Carotid angioplasty patients may also receive an ultrasound of the carotid artery after the procedure. However, most patients are discharged from the hospital within 24 hours following carotid angioplasty. Catheter insertion site may often remain swollen, tender & bruised for a few days. Moreover, there may also be a small lump or small area of discoloration in the region of the puncture. Patients can take acetaminophen (Tylenol) in recommended doses as required for discomfort or any other medication which is prescribed by the doctor. Nevertheless, carotid angioplasty patients will need to strictly avoid strenuous activity & heavy lifting of loads for at least up to 24 hours of time following carotid angioplasty procedure.
Carotid Angioplasty Results
Carotid angioplasty & stent placement for most people will invariably increase blood flowing through the previously blocked carotid artery & thereby effectively reduce the amount of risk and/or symptoms of stroke. Nevertheless, patients must seek emergency medical care in case their signs & symptoms return including having trouble speaking or walking, numbness on one side of the body, or other symptoms which are similar to those that they used to have before undergoing this procedure. However, carotid angioplasty & stent placement are not appropriate treatment procedures for everyone. Doctors alone can determine if benefits of carotid angioplasty outweigh the potential risks which are involved. Long-term results of this procedure are still under investigation since carotid angioplasty is newer than the traditional carotid surgery. It would therefore be sensible for patients to talk to doctors about the kind of results they can expect & on the type of follow-up care which is required after undergoing this procedure.
Lifestyle Changes Following Carotid Angioplasty
Lifestyle changes including the following will eventually help carotid angioplasty patients maintain good results.
- धूम्रपान से बचें.
- Lower cholesterol & triglyceride levels.
- Maintain healthy weight.
- Regular exercise.
- Control other conditions like high blood pressure, diabetes & sleep apnea.
Affordable Carotid Angioplasty Surgery Cost in India
India has over the past few decades emerged as one of most favorite global healthcare tourism destination providing comparatively high quality yet low cost medical procedure to international patients than what is available for them in their homeland. Vast pool of doctors & surgeons available in India are some of the most reputed & recognized medical professionals having extensive knowledge & training in their respective fields of medicine. Healthcare infrastructure within the country is built upon a sound footing & comprises of numerous internationally accredited hospital facilities equipped with the latest technologies & managed by English speaking professional staff. With convenience of access to medical visas, India nowadays is the most ideal medical tourism destination providing a wide spectrum of affordable healthcare solutions including carotid angioplasty for strokes to patients from all around the world.
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