Carotid Stenting
Tchefuncte Cardiovascular Associates (TCA) was the first cardiology group on the Northshore to perform the carotid stent procedure. Dr. Silva MD, FACC is skilled in carotid stenting.
 Your brain needs a constant supply of blood, oxygen, and food. A significant portion of the blood flow to your brain comes from the carotid arteries. The common carotid arteries are located on both sides of your neck and divide into two vessels, the external carotid artery and the internal carotid artery. The external carotid arteries bring blood to your face. The internal carotid arteries bring blood to the front part of your brain.
One type of carotid disease is atherosclerosis, which is the buildup of fatty substances like cholesterol. This is the same process that causes coronary heart disease. The buildup is often called plaque. This results in a thickening and hardening of the vessel so that the flow of blood is slowed down. This blockage can develop in one or both of the carotid arteries.
A stroke can be caused in one of two ways:
- Plaque buildup narrows the artery so that the flow of blood to the brain is blocked.
- The plaque or blood clots formed on the plaque break off and travel to a smaller artery in the brain, resulting in blockage in that artery.
This lack of blood to the brain causes a stroke called an ischemic (lack of blood) stroke. This can also cause temporary symptoms that seem like a stroke, known as a transient ischemic attack (TIA).
Go to Patient Information on the Home Page to Conditions/Procedures for more detail.
Many people do not have symptoms from carotid artery disease. Some peoples may experience a TIA or stroke. A stroke is a "brain attack." Strokes occur in about 700,000 people in the United States each year. About 280,000 patients die each year from stroke-related causes.
Common signs and symptoms of a stroke or TIA may include:
- Sudden numbness or weakness of the face, arm or leg, especially on one side
- Sudden confusion or dizziness
- Sudden trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, loss of balance coordination
- Sudden severe headache with no known cause
- Sudden trouble swallowing
CALL YOUR TCA CARDIOLOGIST IMMEDIATELY IF YOU HAVE THESE SYMPTOMS. DO NOT IGNORE THESE SYMPTOMS, EVEN IF THEY GO AWAY. THESE ARE WARNING SIGNS OF AN IMPENDING STROKE.
Your physician may suspect that you have carotid artery disease because you have atherosclerosis in other blood vessels such as the heart or legs, or if you have symptoms of a TIA or stroke.
One or more of the following tests may be used to diagnose your conditions:
- History and Physical. Tell your physician your full medical history and any symptoms you have experienced, even if they were temporary.
- Carotid Ultrasound. Ultrasound means sound waves. This test can help the physician see the blood flow through these arteries and if you have any blockages. TCA has ultrasound technologists trained to perform the test in most of our clinic locations.
- Angiogram. A catheter or small tube is used to inject a dye (contrast) into the carotid arteries. Then x-rays are taken to allow the doctor to see any narrowing in your carotid arteries. This procedure is offered at the TCA Vascular Suite.
- Computerized Axial Tomography Scan (CT or CAT Scan). A CT scan uses x-rays to create three-dimensional images of a part of the body. It can be done with contrast (dye) if the physician wants to see the vessels.
- Magnetic Resonance Imaging (MRI). A MRI uses a very strong magnet to make three-dimensional pictures of a part of the body. A MRI can show atherosclerosis of the carotid arteries or areas of the brain damaged by a previous stroke. It can also be done with dye.
Using the information from one or more of these procedures your cardiologist will recommend the most appropriate treatment for you. The physician will explain the risks and benefits of your treatment options. More than one physician may need to be consulted to determine the best approach for you.
- Medications and Risk Factor Changes. Your physician may prescribe blood thinners known as anticoagulant or antiplatelet medications. Common drugs are aspirin, Plavix, Coumadin (also know as Warfarin) or Ticlid. These drugs lower the risks of clots. TCA offers a Coumadin Clinic to help monitor the effects of the drug and adjust the dosage to prevent complications. In addition your TCA physician may prescribe medications to lower your blood pressure or cholesterol. Your TCA cardiologist can assist you to quit smoking, develop an exercise plan, and lose weight.
- Carotid Endarterectomy. Carotid endarterectomy is a surgical procedure that removes the blockage in the carotid artery. An incision is made in your neck and into the carotid artery, the plaque is removed from the artery, and then the artery is closed with stitches. The procedure is usually done under general anesthesia in an operating room. Carotid endarterectomy is one of the most common surgical procedures in the United States and has been performed for over 50 years. This procedure is typically performed by a vascular surgeon.
- Carotid Stenting. Carotid stenting is a relatively new endovascular treatment (done through or inside the blood vessels) for carotid artery disease. You might decide that carotid stenting is a better option for you because you would not need to have the incision in your neck or general anesthesia necessary for a carotid endarterectomy. However carotid stenting does not have the long history that carotid endarterectomy has, although clinical studies have shown that carotid stenting is a safe and effective treatment, especially for people at high risk for surgical complications. Dr. Jose Silva, MD, FACC is able to use carotid stenting to treat individuals with or without symptoms needing the procedure. The TCA billing department is also very skilled in determining your insurance coverage and will assist in educating your insurance company regarding this new procedure.
 The procedure uses a small stent (latticed metal tube) to open the partially blocked artery and to hold the plaque against the artery wall. An embolic protection device is also used to help catch any pieces of plaque or other particles that may be release during the procedure, preventing a possible stroke.
The stent is introduced into the narrowed blood vessel on a catheter after the embolic protection device has been placed beyond the narrowed area of the artery. The physician maneuvers the stent on a catheter into the vessel, and positions the stent across the narrowed area in your carotid artery. The stent is released and stays in place permanently, holding the artery open, improving blood flow. The stent also holds the plaque against the artery wall. This reduces the risk of plaque breaking off, traveling into your brain and causing a stroke. All of the devices, except the stent are taken out of your body at the end of the procedure. This procedure is performed in the cardiac catherization lab. You will be given some medication to help you relax during the procedure.
You may need to stay in the hospital for 1 - 2 days. Before you leave the hospital you will be given instructions on activity, diet, and medications. You will also have a stent Implant Card which you should carry with you.
Take your medications as prescribed. It is important to follow these instructions exactly. These medications will help prevent blood clots from forming in the newly opened artery. Notify your cardiologist if your medications cause unpleasant reactions, but do not stop taking them unless told to do so.
Call your TCA cardiologist or hospital immediately if you have any new symptoms or worsening of symptoms you had before the stent placement:
- Sever headache
- Dizziness
- Slurred speech
- Problems at your puncture site, such as increased swelling, pain or bleeding
- Fever greater than 101 degrees
- Weakness or numbness affecting one side of your body (for instance, your right arm, leg, or face weaker than your left)
- Blurry vision or sudden loss of vision on or both eyes
Call a TCA clinic location close to you. Any of our cardiologists can evaluate you and diagnose carotid artery disease. Dr. Jose A. Silva, MD, FACC will be consulted if you should be a candidate for carotid stenting. The options for treatment will be explained to you. If carotid stenting is chosen for your treatment, the TCA staff will assist in scheduling the procedure, any pre-procedure testing or consults, and insurance coverage determination.
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