Stent placement – stenting – stent implantation
A stent is an implant, e.g., placed in vessels in order to permanently keep them open and prevent a vascular stenosis. The stent is a small tube made of metal or plastic.
Minimally invasive stent placement is normally carried out using local anesthesia. After cannulating the femoral artery, a special catheter system is inserted through the aorta to the throat vessels. This procedure is free of pain because vessels do not have any pain receptors inside. The stent is placed inside the stenotic vessel by assistance of a guide wire and a navigation instruments. In many cases, the stent has to be shaped and dilatated by a special balloon. The risk of apoplectic stroke can emerge in single cases due to the loosening / removal of calcified parts or blood clotsso that a protection system is used. This is only necessary in some cases.
After evaluating of the findings during stent placement, the cannulated area of the femoral artery is closed by a special suture system, and the patient has to keep to bed rest for 12 hours. The patient is frequently surveilled within the first hours after the stent placement. To prevent blood clot emergence at the stent (which is a stranger for the body), the blood clotting agent heparin is applied. During aftercare platelet aggregation inhibitors are prescribed.
The stent grows quickly in the vascular wall. It is elastic, flexible and keeps the vessel open like a spring. It is not magnetic so that MRI examinations are possible. Throughout airport control, it does not sound the alarm and flying is of course practicable.
The danger of a recurring stenosis is similarly high or low compared with open carotid surgery, and it is subject to the individual risk profile of the patient.
If there is a complication despite all precautionary measures, the surgeon recognizes it immediately because the patient is awake. The surgeon can instantly take countermeasures and, if necessary, remove blood clots by drugs and / or special microcatheters from cerebral vessels in order to avert an apoplectic stroke.
In case of open carotid surgery, the vessel is clipped after the opening of the throat above and under the stenosis. Then the surgeon opens the vessel and scrapes out the inner parts comprising sediments. If necessary, a patch is placed and sewed in. After it the vessel is released and the soft tissue of the throat is closed again. This kind of surgery is carried out using general anesthesia, sometimes also local anesthesia.
Both procedures are safe and successful given that they are carried out by an experienced surgeon. Currently, several scientific studies, which are being evaluated and discussed, are in progress proving the equality of both procedures.