Carotid & Vertebral Stenosis

Carotid or vertebral angioplasty and stenting, is a minimally invasive procedure performed to open arteries clogged by fatty deposits (plaque) to improve blood flood to the brain and prevent future stroke. During this procedure, a small balloon (angioplasty) and/or a wire mesh insert (stent) is threaded through a catheter to the area of blockage and opened up, restoring normal blood flow and decreasing the chances of the artery narrowing again. No neck incision is required. 

Prior to the procedure patients will be placed on two antiplatelet medicines, Aspirin and Clopidogrel, in order to prevent clots from forming. Patients can expect to remain on aspirin indefinitely and clopidogrel for 1-3 months depending on individual circumstances that Dr. Geraghty will discuss with you. Carotid and vertebral stenting is typically performed under sedation administered by an anesthesiologist, although in certain circumstances, such as when the narrowing is intracranial, general anesthesia may be used. Following the procedure, patients usually spend one or two nights in an ICU and are then discharged home. As with aneurysm treatment, full recovery from carotid or vertebral artery stenting takes approximately one week.

Intracranial Angioplasty & Stenting

Angioplasty and stenting is typically done to treat the arteries within the neck, although in some cases it can also be performed to treat narrowed arteries in the brain as well. These are cases where medical management has not been successful and can be discussed in more detail on an individual basis during consultation with Dr. Geraghty.

Both carotid endarterectomy and carotid stenting are highly effective treatments. Dr. Geraghty has performed hundreds of carotid stenting procedures such as those below:

 
 

What are the Carotid Arteries?

The carotid arteries are major blood vessels located on both sides of the neck that pump blood from the heart to the neck, face and brain. Each carotid artery breaks off into two divisions:

  • The internal carotid that supplies the brain with blood

  • The external carotid that supplies blood to the face and neck

What are the Vertebral Arteries?

The vertebral arteries are two major blood vessels located on both sides in the back of the neck that pump blood from the heart to the brainstem and back of the brain. The vertebral arteries join together to form the basilar artery which is a central artery that runs along the brainstem.

What is Carotid or Vertebral Artery Stenosis?

Carotid or vertebral stenosis—also known as carotid or vertebral artery disease—is a slow buildup of plaque (known as atherosclerosis) on the internal walls of the artery, resulting in restricted blood flow and increased risk of stroke. The plaque is made up of cholesterol, fibrous tissue and calcium, as well as other cellular debris that adheres to microscopic cracks forming in the artery walls.

Symptoms

In the early stages of the disease, signs and symptoms don’t generally appear. In fact, carotid or vertebral stenosis may go undiagnosed until a stroke or transient ischemic attack (TIA) occurs. (A TIA is a “ministroke” that does not cause permanent symptoms.)

  • Transient blindness in one eye, often described as a shade coming down over the eye. This is known as “amaurosis fugax.”

  • Loss of balance or dizziness

  • Face drooping, where one side of the face droops or the smile is uneven

  • Speech difficulty, where speech is slurred, the patient is unable to speak, or the patient is hard to understand

  • Sudden weakness or numbness in the limbs or face, typically only on one side

  • A severe headache that occurs abruptly

Note: If you or someone you know is experiencing signs of a stroke, please dial 911 immediately. Any delay in care could result in serious complications or death.

Risk Factors for Developing Carotid or Vertebral Stenosis

Factors that increase the risk of carotid or vertebral stenosis may include:

  • Nicotine can inflame the walls of the arteries, and smoking can cause high blood pressure, as well as an increased heart rate

  • A sedentary lifestyle. A lack of regular exercise contributes to other conditions or diseases that can result in carotid stenosis, including high blood pressure and diabetes

  • Being diabetic makes it more difficult for the body to process fats, which can lead to high blood pressure and plaque development

  • Family history. The risk is higher in those with relatives who have atherosclerosis or stenosis

  • High blood pressure. Increased blood pressure places a strain on the artery walls, making them more susceptible to injury

  • Excess weight increases the risk of developing high blood pressure, diabetes and atherosclerosis

Diagnosis

Following a thorough examination, where a bruit (“whooshing” sound) may be heard on physical exam, carotid or vertebral stenosis may be diagnosed using diagnostic imaging, such as:

  • Ultrasound to evaluate blood pressure and flow in the arteries

  • CT angiography or an MR angiography, which use contrast dyes injected into a blood vessel to view blood flow to the neck and brain

Treatment

Treatment for carotid and vertebral stenosis depends on the severity of the blockage and if the patient is symptomatic. If the blockage is mild to moderate and the patient isn’t experiencing any symptoms, lifestyle changes (e.g., changing diet, quitting smoking, losing weight, etc.) and medications can effectively manage the condition. If the blockage is severe (or the patient has already suffered a stroke or TIA), treatment may be required to fix the blockage. Procedures to do so include:

  • Carotid endarterectomy, a procedure in which the artery is opened through an incision in the neck, and the plaque is removed

  • Carotid or vertebral angioplasty and stenting, is a minimally invasive procedure where a small wire mesh insert (stent) is threaded through a catheter to the area of blockage and opened up to improve blood flow and prevent future narrowing. No neck incision is required.