Cerebral angioplasty is a minimally invasive procedure to open a carotid artery that is narrowed or blocked.
Carotid arteries are the blood vessels that bring blood to the brain and neck. They are situated on each side of the neck. The carotid can be partially or completely blocked by a fatty substance called plaque. A plaque is a material made of cholesterol, fat, calcium, protein and, cellular waste.
A blockage can reduce the supply of blood in the brain. Some parts of the artery plaque can break off and create another blockage. A partial blockage is called Carotid artery stenosis (narrowing). If the brain does not receive enough blood supply, a stroke can occur.
Symptoms of a blocked carotid artery
Patients experience Stroke or Mini-stroke/ Transient Ischemic Attack (TIA) with symptoms such as:
- Sudden severe headache
- Sudden weakness of the limbs or face usually on one side
- Dizziness or loss of balance
- Trouble with vision in one or both eyes
- Trouble speaking or understanding
Types of Procedure
- Endarterectomy: A surgery to physically remove plaque from the inside of the artery of the neck.
- Carotid angioplasty with stent placement (CAS): A surgery involving inserting and inflating of a tiny balloon to open the artery and placing a small metal stent (wire mesh) to maintain an open artery to prevent further blockage.
Indications for Endarterectomy
Endarterectomy is a more traditional procedure but safe and effective to treat blocked or narrowed arteries for issues below:
- When the blockage is 50 – 79% in the carotid artery and experiencing symptoms such as stroke, mini-stroke, or Transient Ischemic Attack (TIA)
- A severe (80%) blockage with no symptoms.
Indications for CAS Procedure
CAS is a good alternative and may be favored due to the following reasons:
- When the person is too ill to have carotid Endarterectomy
- When surgery is harder to perform due to the location of the narrowing artery
- When the person has had neck or Carotid surgery previously
- When the person has had radiation in the neck.
Diagnosis and Tests
- Physical examination
- Carotid ultrasound
- Carotid angiography
- Blood tests
- Physical examination of affected areas
- Diagnostic tests will be performed
- Your doctor reviews your results and medical history
- Any current medications or allergies must be mentioned
- You may be asked to stop some medications like diabetic medications or blood thinners before surgery
- Take approved medications with small sips of water
- You will be asked to fast 8 – 12 hours before surgery
- You will also need to stop smoking
- If you are having Carotid surgery with stent, your groin area will be shaved and prepared for surgery
- You will receive local or general anesthesia in the neck or groin depending on the surgery
- The surgery will last around 1- 2 hours depending on the type of blockage
- For Endarterectomy, the surgeon makes an incision at the front of your neck
- The plaque is physically removed from the artery
- The artery is then repaired by natural graft, where a piece of vein from the body is taken or a woven patch is made
- For Carotid surgery with stent, small electrodes are placed on your chest to monitor your heart rate and rhythm during the surgery
- Once a small incision is made in the groin area, a small catheter is inserted up to the neck where the blockage is under the guidance of an X-Ray
- Through the catheter, a contrast material is injected into the carotid artery to see images of the blocked arteries and the blood flow to the brain
- A filter is placed beyond the narrowing to catch any debris that may break off while performing the procedure
- A balloon tip is inserted in the narrowing and inflated to push the plaque to the wall of the artery and open the passage
- A small metal tube called stent is inserted in the artery to prevent further blockage
- The filter, catheter and, balloon is removed
- The incision does not need any stitches, but pressure is applied to stop bleeding and, a dressing is done on the site.
- You may need to lie down sometime after the surgery to prevent any bleeding
- You will stay overnight at the hospital but varies depending on your physical health
- You will experience soreness around your throat under Endarterectomy surgery
- Under CAS, the surgical site may be bruised or swollen for a few days, but this is normal
- An ultrasound of the carotid artery may be taken yearly to examine the plaque is not accumulated again
- Medications will be given to alleviate any pain
- You may need to avoid strenuous activities for at least 24 hours after surgery
- Lifestyle changes like diet and exercise may be needed
- Follow up will be scheduled.
Risks and complications
Though surgery is safe, it is not without complications however, this is minimal.
- Nerve damage affecting voice box, tongue or back
- Heart attack
- Allergic reaction to dye
- Blood clots
- Brain damage
- In-stent restenosis
- Kidney failure
- More blockage in the carotid artery over time
Factors affecting cost of Cerebral angioplasty
Many factors such as below affect the cost price.
- Choice of hospital
- Location of the hospital
- Surgeon’s fee
- Cost of blood and diagnostic tests
- Type of treatment and surgery
- Medicinal costs
- Duration of stay
- Cost of post-surgery care