Published Scientific Articles
Patient Handout

Published Scientific Articles

Carotid Stenting in Patients with Symptomatic Coronary Artery Disease: A Preferred Approach. Fayaz Shawl, MD. The Journal of Invasive Cardiology, September 1998.

Emergency Percutaneous Carotid Stenting During Stroke. Fayaz Shawl, MD. The Lancet, November 1995.

Safety 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, June 2000.



Patient Education Handout for Treatment of Carotid Artery Disease

What is Carotid Artery Disease?

Carotid 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.

How Is Carotid Artery Disease Diagnosed?

There are several ways to diagnose narrowing in the carotid arteries.

1. 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.

2. 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.

3. 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.

Treatment of Carotid Artery Disease

There 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.

Before the procedure

Dr. 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.

During the Procedure

Your 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.

After the procedure

After 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.

Taking Care of Yourself at Home

When 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.


Contact 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.


Dr. 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.

Follow-up Examinations

You 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.

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