Internal Carotid Stent and Angioplasty

Internal Carotid Angioplasty and Stent in Thousand Oaks, CA

The internal carotid artery is the main vessel that supplies blood to the brain. Atherosclerosis, or the buildup of fatty plaques inside the artery, can constrict the blood vessel and reduce the amount of oxygenated blood that reaches the brain. When narrowing of the internal carotid artery disrupts blood flow, a stroke can occur. Fortunately, internal carotid stenosis can be treated by a highly skilled neuroendovascular surgeon through a minimally invasive procedure known as internal carotid angioplasty and stent (CAS).  

Dr. M. Asif Taqi is a triple-board certified neurointerventionalist and stroke prevention specialist who has years of experience and extensive expertise in treating carotid artery disease. Dr. Taqi understands the emotional challenges when you or your loved one receives a diagnosis of carotid stenosis or stroke. In addition to his superior technical skill in neuroendovascular surgery, Dr. Taqi’s own family experiences have prepared him to become the kind of compassionate and empathetic physician that you’ll want on your side. He strives to ensure the comfort of each of his patients as he takes the time to explain your angioplasty and stent procedure and answer any questions you might have.  Contact us today to arrange your consultation in Thousand Oaks or West Hills.

What causes carotid artery disease?

Oxygenated blood leaves the heart through the aorta and then travels upward through the common carotid arteries on either side of the neck. These common carotid arteries split into an internal and external branch on each side, and it is at or near this split that atherosclerotic plaques are most likely to cause stenosis. Plaque buildup in the artery can occur for many reasons; the most common risk factors that may contribute to plaque formation are high blood pressure, high cholesterol, smoking, obesity, and heart disease. Generally, older people are more likely than younger people to suffer from carotid stenosis. 

Internal carotid stenosis, also called carotid artery disease, can prevent optimal blood flow to the brain, causing periods of ischemia (interrupted blood flow) or stroke. Additionally, plaques can sometimes become unstable and provoke blood clot formation, which can also cause a stroke. In fact, carotid artery stenosis causes an estimated 10-20% of all strokes (Flaherty et al 2013).

Though many patients discover they have carotid stenosis when they have neurological symptoms or even a stroke, it is also possible to have asymptomatic carotid stenosis. Your risk of stroke depends on many factors, such as whether you have had neurological symptoms or a previous stroke, the exact composition of your plaque, and any other health conditions that you have (Howard et al 2015; Nicolaides et al 2005). Though it is impossible to predict whether or not you will have a stroke if you have carotid artery disease, Dr. Taqi can use the growing body of scientific evidence to estimate your risk of stroke and develop a treatment plan accordingly. 

diagram of neck arteries

How is an internal carotid angioplasty and stent placed?

Patients with internal carotid stenosis commonly undergo carotid angioplasty and stent placement (CAS), as this minimally invasive procedure is recommended to significantly reduce the risk of stroke in certain patients (Brott et al 2011). In particular, CAS is recommended for certain patients who have a high degree of stenosis and are symptomatic. As a researcher and a surgeon, Dr. Taqi is fully committed to treating patients according to the best scientific evidence and with the most advanced, safe, and effective approaches.

During this minimally invasive endovascular procedure, Dr. Taqi will insert a flexible small tube called a catheter into the femoral artery in the groin, guiding it along the connected blood vessels of the body up to the affected area of the internal carotid artery. When the catheter reaches the treatment site, the angioplasty can be performed.

Angioplasty inflates a small balloon at the treatment site to push the plaque to the side, compressing it and re-opening the stenotic vessel. Afterwards, the balloon is deflated and removed, allowing for placement of the stent. The stent is a mesh-like tube that will hold open the stenotic vessel to re-establish and ensure sufficient blood flow, and it will stay in place permanently. After stent placement, Dr. Taqi will remove the catheter and close the small incision in the groin.

What is TCAR and how is it beneficial?

One risk of carotid angioplasty and stenting is stroke that may occur during the procedure. A new, minimally invasive procedure called transcarotid artery revascularization (TCAR) has been shown to reduce the risk of stroke during carotid stent placement. Dr. Taqi is the only neuroendovascular surgeon in the area to perform this state-of-the-art procedure.

TCAR uses a new device called a transcarotid neuroprotection system (NPS) that allows direct access to the carotid artery and temporarily reverses blood flow during the procedure to protect the brain from any debris that might be dislodged during surgery. Blood is passed through a specialized filter to capture any plaque that is removed and then returned to the body (in the upper leg). After the stent is placed, the blood flow reversal is turned off and the NPS is removed. In this way, the brain is protected during the entire procedure, and the risk of stroke that occurs because of the possibility of dislodging bits of plaque during stenting is eliminated. Though this new approach has been demonstrated safe and effective in reducing the risk of stroke that is associated with carotid stenting, not all neurointerventionalists have been trained to be able to implement this life-saving approach. Dr. Taqi prides himself in staying current with ever-advancing technology and receiving ongoing training so that he may always offer the most beneficial techniques to his patients.

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Alternate treatments for internal carotid stenosis

Though it has been proven effective to reduce the risk of stroke for many patients with carotid artery stenosis, CAS is not always the best procedure for everyone.  Other options include medications to diminish the buildup of the atherosclerotic plaque and more invasive surgery called carotid end-arterectomy (CEA). Dr. Taqi will be able to make the best recommendations for you after reviewing your images and medical history and conducting a physical exam that may include additional diagnostic imaging.

Recovery from carotid angioplasty and stent

Because CAS is performed endovascularly, it is considered a minimally invasive procedure, and the recovery from the procedure is not extensive. Dr. Taqi advises patients who have had an endovascular procedure such as CAS to take a few days off from work to rest.  You will likely be discharged to go home on the same day as your procedure, but you will need someone to drive you home after surgery and stay with you for a while. You should not lift anything heavier than 10 pounds for a few weeks to protect the incision in your groin as it heals. When you see Dr. Taqi for your follow-up appointment, he will let you know when you can get back to your regular activities.

Internal Carotid Angioplasty and Stent FAQs

To get the most out of your consultation with Dr. Taqi, you’ll want to first make sure you have gathered your past medical records. You can obtain the results of your previous scans or imaging studies in DVD format. It can also be helpful to bring a copy of your past provider’s notes, in case electronic medical records have not been shared. Dr. Taqi will also want to know about any medications and over-the-counter drugs you are taking. And, be sure to bring a list of any questions you might have. Dr. Taqi understands that neurovascular conditions can be overwhelming, and he will patiently answer your questions to ensure that you are comfortable with your procedure. Having all of this information at the ready for your meeting with Dr. Taqi will ensure that you have the most effective consultation possible.

Many patients discover they have carotid artery disease when they begin experiencing neurological symptoms and seek medical attention. In other cases, a doctor performing a physical exam may listen to the blood flow of the carotid artery and hear a noise called a “bruit” that indicates narrowing of the vessel. Final diagnosis of carotid artery stenosis is made through testing such as ultrasound of the neck, a CT angiogram, magnetic resonance angiography, or a cerebral angiogram.

CAS is performed to minimize your chances of suffering a stroke, but no surgery is without its risks. The most common risks associated with carotid angioplasty and stent are restenosis of the blood vessel, bleeding, clot formation, and stroke.

If you or your loved one have been given a diagnosis of carotid artery disease, get the opinion of Southern California’s leading stroke specialist and experienced neurointerventionalist, Dr. M. Asif Taqi, to determine whether internal carotid stent and angioplasty is right for you.  Contact us or call 805.242.4884 to schedule your appointment today.

References

Brott, T.G., Halperin, J.L., Abbara, S., Bacharach, J.M., Barr, J.D., Bush, R.L., Cates, C.U., Creager, M.A., Fowler, S.B., Friday, G., Hertzberg, V.S., McIff, E.B., Moore, W.S., Panagos, P.D., Riles, T.S., Rosenwasser, R.H., Taylor, A.J. (2011). ASA/ACCF/AHA/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Journal of the American College of Cardiology. 57: e16-94.

Flaherty, M.L., Kissela, B., Khoury, J.C., Alwell, K., Moomaw, C.J., Woo, D., Khatri, P., Ferioli, S., Adeoye, O., Broderick, J.P., and Kleindorfer, D. (2013). Carotid artery stenosis as a cause of stroke. Neuroepidemiology. 40: 36-41.

Howard, D.P., van Lammeren, G.W., Rothwell, P.M., Redgrave, J.N., Moll, F.L., de Vries, J.P., de Kleijn, D.P., den Ruijter, H.M., de Borst, G.J., and Pasterkamp, G. (2015). Symptomatic carotid atherosclerotic disease, correlations between plaque composition and ipsilateral stroke risk. Stroke. 46: 182-189.

Nicolaides, A.N., Kakkos, S.K., Griffin, M., Sabetai, M. Dhanjil, S., Tegos, T., Thomas, D.J., Giannoukas, A., Geroulakos, G., Georgiou, N., Francis, S., Ioannidou, E., and Dore, C.J. (2005). Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study. European Journal of Vascular and Endovascular Surgery. 30: 275-284.