Stenting in Patients with Symptomatic Coronary Artery
Disease: A Preferred Approach. Fayaz Shawl,
MD. The Journal of Invasive Cardiology, September
Percutaneous Carotid Stenting During Stroke. Fayaz
Shawl, MD. The Lancet, November 1995.
and Efficacy of Elective Carotid Artery Stenting in
High-Risk Patients. Fayaz Shawl, MD, Waleed
Kadro, MD, Michael Domanski, MD, Fernando Lapetina,
MD, Aleem Iqbal, MD, Kathy Dougherty, CRTT, RCVT,
David Weisher, MD, Jaime Marquez, MD, and Tariq Shahab,
MD. Journal of the American College of Cardiology,
Education Handout for Treatment of Carotid Artery
is Carotid Artery Disease?
arteries supply blood with oxygen to the brain to
make it function properly. Carotid artery disease
occurs when the inner walls of the carotid artery
thicken due to a build-up of cholesterol and other
fats, calcium and other elements carried in the blood.
Carotid artery disease is responsible for approximately
20% - 30% of strokes. Stroke is the third highest
cause of death in America today. It is also the leading
cause of severe long-term disability.
Is Carotid Artery Disease Diagnosed?
There are several ways to diagnose narrowing in the
Carotid ultrasound is the use of sound waves
to obtain a medical image of the carotid blood flow.
A transducer will be moved slowly over the neck. You
won't feel a thing except for the slight pressure
and movement of the transducer over the neck. The
transducer sends a signal to a computer, which processes
the data and produces an ultrasound image. It is from
this image that the diagnosis is determined.
MRA uses a magnetic field and radio waves instead
of x-ray to display many parts of the body. The exam
usually takes 30-60 minutes. MRA is very safe and
there are no health risks associated with the magnetic
field or the radio waves used by the machine.
Carotid angiography is a procedure where dye
is injected into a catheter that has been placed at
the carotid artery. Rapid x-ray pictures are then
taken to show the presence or absence of blockages
in the carotid arteries. After viewing the pictures,
your doctor will know how many (if any) blockages
you have, where each one is located, and the seriousness
of the blockage. This information will help your doctor
decide how best to treat you.
of Carotid Artery Disease
are two ways to treat blockages or narrowing of the
carotid arteries. The traditional standard of care
in treating carotid artery disease has been carotid
endarterectomy. Endarterectomy is an operation in
which the blockage is removed surgically through an
incision in the neck. However, in certain patients,
an alternative form of treatment has been carotid
artery stent placement. Though still in experimental
stages, carotid artery stent placement has been shown
to be an effective and relatively safe means of treating
carotid artery disease.
Shawl and his staff will instruct you on how to prepare
for the angioplasty and stent procedure before you
come to the hospital. Dr. Shawl may ask you to take
aspirin and plavix for several days before the procedure.
This is done to "thin" the blood to prevent blood
clots from forming during the procedure. It is important
to tell us if you cannot take aspirin, have a history
of bleeding problems, if you are taking any other
medications, or have any drug or dye allergies. You
may be instructed not to take any high blood pressure
medication and/or diabetic medication (pills or insulin)
the morning of the procedure. If you take Glucophage,
you will be told not to take it for 48 hours before
your scheduled procedure.
angioplasty procedure and the stent implantation will
be performed in a specially equipped area of the hospital
called the catheterization laboratory. You will lie
on a hard table near a camera and other equipment.
Dr. Shawl will numb an area on your groin or arm and
insert a thin tube, or sheath, into your femoral artery
and then pass a long tube, or catheter up to the carotid
artery. Special dye goes through the catheter so arteries
show up well on the x-ray. Many x-rays are taken during
the procedure. You may feel a warm and tingling sensation
when the dye goes in. You will also be asked to hold
your breath, cough or squeeze on a toy at certain
times during the procedure.
the procedure, you will return to transcare where
the nurses and technicians will monitor you very closely
for several hours. Your blood will be tested frequently
to check medication levels that control the clotting
of your blood. Your family and friends may visit you
in the recovery area once the nurses have assessed
your condition and made you as comfortable as possible.
Before going to your room, the sheath that was used
to enter the vessel will be removed from your leg
and pressure applied to the puncture site until the
bleeding has stopped. You may then drink and eat,
if permitted. Drinking plenty of fluid helps to flush
the dye used during the procedure out of your system.
You will stay in the hospital at least one night,
depending on how well you do following the procedure.
The neurologist will again examine you the morning
after your procedure and if there are no problems
you will be able to go home later that day. Longer
hospital stays are expected for any complications
or other medical problems. Your doctor will advise
you when to increase your activities.
Care of Yourself at Home
you return home, you have an important role to play
in your recovery. For the first few days, your doctor
will restrict your activities. In a small number of
patients, dizziness may occur due to manipulation
of the blood pressure center in the carotid artery.
This is temporary and should improve in the first
week after the procedure. When changing positions
from lying to sitting and/or standing make sure you
do it slowly. This will give your body time to adjust
to the change of blood pressure and will decrease
the chance of lightheadedness and dizziness.
Dr. Shawl's office (301-891-8570) or go to the hospital
immediately if you experience pain, bleeding, discomfort
or changes in mental status, such as confusion. You
may need to call 911 to take you to the hospital.
Follow Dr. Shawl's instructions exactly regarding
the use and dosage of medications prescribed. Tell
your dentist or other medical personnel you are on
blood thinners prior to any treatment. Postpone dental
work until after your recovery.
Shawl may prescribe a number of medications. Two commonly
prescribe medications are aspirin and plavix. It is
extremely important to take these medicines without
missing any doses as they "thin" the blood to prevent
blood clots from forming and sticking to the inside
of the stent. You will need to take aspirin indefinitely,
but Dr. Shawl will let you know when you can stop
taking the plavix. Until then, you should take all
your medications EXACTLY AS PRESCRIBED. Check with
your doctor before taking any over the counter medicines
especially antacids as they may decrease absorption
of aspirin and other medications.
will need to see Dr. Shawl for routine follow-up examinations.
During these visits, Dr. Shawl will monitor your progress,
evaluate your medications. You will also have a carotid
ultrasound at approximately 1 month, 6 months and
1 year (and yearly thereafter) after the stent is
put in to evaluate the status of your stent. You may
also need another ultrasound sooner if there is suspicion
of re-blockage. If your ultrasounds continue to be
abnormal, you may need another carotid angiogram to
more accurately evaluate the status of your stent.
You should also follow-up with the neurologist the
first, sixth, and twelfth month after the procedure.
Contact us at our office, or call (301) 891- 8570.