Dr. Shailendra Trivedi
Cardiologist and Angioplasty specialist
Carotid Stenting is a new modality to treat blockage in the Carotid artery of body by means of deploying a small mash like tube in that blood vessel. This procedure is suitable for patients of cerebrovascular disease who are either predisposed to paralysis or have had a reversible paralytic attack due to deposition of cholesterol containing blocks in the Carotid arteries. These arteries are situated on either side of our neck and one of its main branches supplies a large part of our brain. Formation of blood clot or partial blockade of this vessel leads to what we call as Ischemic stroke. It can lead to serious damage to a part of the brain or may even lead to loss of life.
When the carotid arteries are diseased cholesterol particles and platelets can flow along the blood stream (called embolisation) to brain and manifest as transient paralytic attacks called TIAs. Research has shown us that 30-40% of patients who develop paralysis have this kind of transient paralytic attacks before they develop a dense or disabling paralysis. It has also been proved that the cause for 75% of Ischemic strokes lies in the carotid arteries.
A few of the symptoms of TIAs are transient paralysis of upper/lower limbs, sudden blackout in front of one eye or temporary blindness of one eye, difficulty in pronouncing words, asymmetry of the face, confused state of mind etc. This is also important to note that most of these symptoms are on the opposite side of the diseased carotid artery and corresponding portion of the brain.
Most important of the risk factors leading to paralysis is High Blood pressure or Hypertension. This is the very reason one should not neglect his/her elevated blood pressure and take regular medications along with life style changes as prescribed by physician.
If one has any of the above mentioned symptoms an immediate consultation with a physician is necessary. On his advice the patient has to undergo a few tests of which Carotid ultrasound and Doppler examination is the best screening test. One may need to undergo MR angiography, CT angiography and a conventional catheter angiography to complete the diagnosis and decide about the further management of the patient.
The mainstay of treatment of Carotid artery disease is medical therapy but in the few patients when it fails to control the paralytic attacks then patients need mechanical interventions like either carotid stenting or surgical removal of block known as carotid endartrectomy. Carotid stenting is gradually being accepted as equally good alternative to surgery in the developed world and more patients are getting the benefits of this procedure. This treatment modality is definitely indicated for patients who carry a high risk of surgery like those who have bilateral carotid disease or totally occluded other carotid artery, or those with associated serious heart disease or those with short necks or those with severe disease of neck bones etc. Although as with any other modality of treatment carotid stenting also carries risk of some complications but with improvement in technology, understanding of disease and operator skills the rate of complications is getting less and less. After a successful carotids stenting procedure the patient is back to work in a matter of 3-4 days and escapes from major surgical procedure.
About Dr. shailendra Trivedi :
Dr. Shailedra Trivedi M.D. in Medicine from M.G.M. Medical College, Indore (M.P.) has been serving the people of Indore for more than 10 years. He also conducted awareness programmes in society. He is immediate past Secretary of the Cardiological Society of India, Indore branch, where regular clinical meetings, CME programmes, workshops etc as part of educational activities are organized. Now he is working CHL Apollo Hospital, Indore as Consultant & Interventional Cardiologist.