During the surgical procedure, a long thin tube called a catheter is inserted into the artery. This is used to move instruments through the artery to put the stent in place. Your doctor will need to talk to you during the procedure, so you’ll be awake the entire time.
The skin in the area of the insertion site is first cleaned with an antiseptic solution. It is then numbed with local anesthetic.
A puncture is made usually in the femoral artery located in the groin, although an arm or even neck artery may be used.
An introducer sheath or tube is inserted into the puncture.
The catheter is inserted into the sheath. Using X-rays as a guide, the doctor moves the catheter through the sheath and up through the aorta and into the carotid artery.
An angiogram of the carotid artery is taken. A contrast dye will be injected into the artery to show the location of the narrowed portion on X-ray. You may feel a warm sensation toward your head just after the dye is injected. Also, you may think you see some flashing lights. This is normal and will only last for a few seconds. If it persists, let your doctor know immediately.
A filter or other protective device prevents pieces of plaque from being carried downstream into the brain and causing a stroke. The catheter is used to place the unopened filter in the artery and advance it past the narrowed area. The filter is then opened. It remains in place for the whole procedure. If narrowing is very severe, the artery may need to be widened before the filter is put in place.
The narrowed artery will be opened up or expanded if the narrowing is too tight to allow the stent to pass through. This is done using balloon angioplasty:
A tiny uninflated balloon is first moved to the area that needs to be widened.
The balloon is then inflated, pushing the artery open. The balloon may need to be inflated and deflated several times to open the artery enough.
After the procedure is done, the balloon is deflated and removed.
A stent is a metallic mesh tube that is used to expand a narrow artery and to keep it open.
The stent is moved to the site of the narrowing. It is then expanded and deployed using balloon angioplasty. You may feel a slight pain in your neck during the balloon angioplasty.
The catheter and balloon are then taken out, leaving the stent in place.
An angiogram is taken again and compared with the one that was taken at the beginning of the procedure. Once your doctor is satisfied with the result, the filter and other instruments are withdrawn. The insertion site is then closed.