Assuta MC - the largest network of private clinics in Israel that has existed since 1934. It has a specialized branch of modern cardiac surgery . Medical Complex offers the best doctors with the required specialization, skill and experience. The effectiveness of the treatment is directly connected with the center level of technical equipment. Referring to Assuta, the patient will receive medical care corresponding to the highest international standards.
Price carotid stenting
The estimated cost of the procedures in Assuta is $ 15,000. For more information, you can request using the request form or by calling + 972-544-76-19-19
About Carotid artery stenting
This is a minimally invasive method of treating a disease of the carotid arteries, a relatively new approach - efficient means of restoration of blood flow through the blocked blood vessels.
Carotid endarterectomy showed a decrease in the incidence of stroke in patients with symptomatic and asymptomatic stenosis. Given the current developments in the field of endovascular stenting technology has become more sophisticated treatment option illness of the carotid artery than carotid endarterectomy, but less aggressive and invasive.
The problem of stenting - to prevent stroke in the future.
What is the disease of the carotid arteries?
Two common carotid arteries moves oxygenated blood to the head and neck. These vessels are lifted by the neck, where each is divided into two branches - external carotid (blood provides an outer part of the head, face and a larger segment of the neck) and the inner (supplies blood inside the skull and orbital region) .
Carotid artery disease (stenosis) represents its restriction, caused by atherosclerosis. Because of this disease through the bloodstream travel cholesterol accumulation, fat and other substances (inflammatory cells, cellular waste products, calcium and proteins). These segments adhere to the walls of blood vessels and eventually form layers, which become a cause of narrowing or occlusion of the carotid arteries, providing an increased risk of stroke.
Treatment options for this disease has historically included a combination of medications, lifestyle changes and surgery known as carotid endarterectomy. During the surgeon makes a small incision in the neck and removed atherosclerotic plaques. However, many patients with stenosis have co-morbidities that make them poor candidates for this operation. For these patients and for those with artery blockage has reached 80% or more (and for a number of other indications) offers a less invasive approach to disease treatment - stenting. In 2004, this procedure was approved by the FDA.
Indications for stenting of the carotid artery:
- Intolerance of general anesthesia in carotid endarterectomy.
- The history of contralateral vocal cord damage.
- Previous neck surgery on the ipsilateral side.
- The irradiation of the neck.
- Restenosis after carotid endarterectomy.
The study of this approach is still ongoing, comparing the results of stenting and carotid endarterectomy surgery. More recently, following the results of a large randomized trial published, it was found that there were no significant differences in the main risks associated with these two types of treatment in the medical journal New England (the New England Journal of Medicine). Also stenting is as effective as traditional surgery for the removal of atherosclerotic stratification in patients with a high risk for open surgery.
Contraindications to carotid stenting:
- An allergic reaction to intravenous contrast material.
- Unfavorable anatomy.
- Unstable plaques of carotid artery.
- Unstable plaques of the aortic arch.
- There are contraindications to anticoagulants and antiplatelet agents.
- It occurs allergic to cobalt, chromium, or nickel used in stents.
Preparation for carotid stenting in Assuta
- It is important to tell your doctor about any medications the patient is taking, and take them with you.
- It is necessary to inform the doctor about the presence of allergy, especially to contrast media, iodine and metals (cobalt, chromium, nickel, titanium or stainless steel) or plastic (polyurethane).
- If the patient can not take aspirin or clopidogrel, it is necessary to inform the expert, as These drugs are usually taken before and after the procedure.
- Do not eat or drink after midnight the night before stenting.
- It is important to be sure to follow the instructions that will give the treating physician.
- Make sure to fully understand the potential risks and benefits of stenting of the carotid arteries.
Carotid angriografiya - an invasive X-ray procedure that makes it possible to determine the narrowing and blockage in the carotid arteries and to identify the risk of future stroke. It is carried out when there is a suspicion of stenosis based on the results of other tests - duplex scanning of neck vessels, CT angiography, magnetic resonance angiography.
What happens during carotid angiography?
Your doctor may prescribe a medicine antisvertyvayuschey, such as heparin, to reduce the risk of blood clots. Also recommend taking aspirin and / or Plavix (clopidogrel bisulfate) for three to five days before the procedure and for 4-6 weeks afterwards. The doctor will advise detailed way what you can and can not eat and drink before the angiography.
Local anesthesia is applied to the area where the introducer is inserted. A thin, hollow tube, the doctor inserts the blood vessel in the leg (femoral approach) or arm (humerus). Through this catheter tube is inserted and passed through the aorta to the carotid artery under X-ray control.
Through a catheter introduced into a contrast agent, images are created as the contrast passes through the carotid artery. Digital photos help to identify the location of stenosis or blockage.
If the results indicate a significant narrowing or blockage of the carotid artery can be performed angioplasty and stenting, to expand the vessel or recommended surgery.
What happens during the carotid artery stenting?
Interventional cardiology and interventional neuroradiologist at Assuta together spend stenting. The patient is given a mild sedative intravenously. He feels sleepy and relaxed, being conscious to follow the doctor's instructions and describe the sensation. Devices that control heart rate and blood pressure, are attached to the body.
Access for stenting the carotid artery can be obtained by using different approaches:
- Femoral - the most preferred by most physicians, provides better maneuverability.
- Shoulder / groove - associated with the risk of damage to the median nerve, there are difficulties in the manipulation of the catheter.
- Carotid - is associated with the risk of unintentional dissection of stenosis, is not actually used.
The doctor performs a small incision in the groin, on the hand or wrist. In most cases the procedure is performed through the femoral artery in the leg. The area where the catheter will be inserted, numbed with a local anesthetic.
Through the incision, the doctor inserts a catheter, advancing it to the narrowed section of the carotid artery. Then, through the catheter enters a contrast agent. It helps to see him vessels of the neck of the monitor. The patient may experience a short time heat gain.
Thereafter, the special filter is fed through the catheter and positioned just outside of the affected area. This small device is part of a system - embolic protection device. It looks like an umbrella and a basket to capture embolic material (thrombus, different particles). Filtering prevents these substances to move through the bloodstream to the brain, thereby reducing the risk of blood clots or strokes.
The doctor then sends a small balloon catheter to the blockage area. When the balloon is inflated, compresses the atherosclerotic layering, expands the artery diameter. The balloon was removed, and the stent is placed within the vessel to expand the hole and keep the artery wall.
Then the doctor performs angiography, to obtain confirmation that the stent is fully expanded, narrowing or blockage is eliminated. Often they use the second balloon catheter to inflate a balloon inside the stent already with a view to a larger opening. Then the balloon, the filter and the catheter withdrawn from the body. The incision is closed. The stent stays in the artery, acting as a supporting frame, keeping the vessel open. A few weeks later the artery around the stent heals.
After carotid stenting
The patient feels sleepy for some time in connection with taking a sedative. First, it is transferred to the intensive care unit, where a patient's condition is observed nurses and doctors.
They check your heart rate, blood pressure, neurological status and the status of the cut.
The patient will be offered to drink plenty of fluids to flush the body of a contrast agent. A few hours will need to stay in bed, give the correct position of the leg (or arm) to accelerate healing. Hematoma at the injection catheter usually take place after 5-7 days.
If the general condition of the patient parameters are favorable, it discharged the next day. Hospitalization in Assuta can last a day or two.
It should tell your doctor if there is any of these symptoms:
- Severe dizziness, blackouts or loss of consciousness.
- Strong headache.
- Sudden blindness in one or both eyes.
- Sudden weakness in the arm, awkward movements.
- Sudden weakness or paralysis of the face, feet or hands.
- Slurred speech or difficulty understanding.
- Pain at the site of the catheter.
It is necessary to avoid strenuous exercise, heavy lifting until the body is restored. The doctor will provide more information on this issue.
Possible complications of carotid artery stenting
Implantation of stents in blood vessels throughout the body and is held constant for a long time, but carotid stenting - a relatively new technique. As with any other procedure, stent placement, there is a possibility of certain complications:
- allergic reactions;
- thrombus formation;
- Injury in the groin or elsewhere in the catheter;
- of death;
- heart attack;
- arterial injury or damage;
- movement of the stent from the place of the initial placement;
- restenosis around or inside the stent;
- stroke or transient ischemic attack.
Assuta Hospital doctors will monitor the patient's condition during and after stenting, to prevent the development of such complications. If this happens, it will be taken appropriate measures to address them.
Statistics show that a small number of people - 1-3 100 undergoing carotid artery stenting, catches stroke during or shortly after surgery.
Rare complication is bleeding, which causes the formation of blood clots around the wound in the groin area - in 1-2% of cases requires a small operation, but usually the blood is removed by the body within 1-2 weeks.
In the presence of other diseases such as angina or bronchitis / asthma possible complication condition during stenting. But it rarely causes serious problems.
The potential benefits of carotid stenting:
- It improves blood flow to the brain by removing atherosclerotic deposits. It reduces the risk of stroke or transient ischemic attack.
- Minimally invasive procedure - as a consequence - a short period of rehabilitation and reconstruction.
Life after carotid artery stenting
The doctor will advise what life should be maintained to improve the condition. This could include measures such as smoking cessation, exercise, regular intake of medication.
Steps to a healthy lifestyle:
- Treatment aimed at reducing high blood pressure.
- Eating foods low in saturated fat and cholesterol intake of sufficient amounts of fluid.
- Reducing excess weight, which reduces the risk of cardiovascular disease.
- At a high level of blood sugar - a decrease.
- In the case of diabetes the regular visits to the doctor and follow his instructions. Diabetics are at greater risk of disease due to elevated blood glucose levels, which speeds up the process of stenosis.
- Medication prescribed by a doctor, for example, aspirin and drugs - antiplatelet agents.
- Reducing the level of stress in your life.
- Follow-up with your doctor after stenting.
- Quitting smoking, as it is the cause of further damage to the arteries, increasing the risk of stroke, heart attacks and problems with blood circulation in the legs.