Cerebral Angioplasty - Procedure, Side Effects, Recovery, Result

Cerebral Angioplasty, also known as Carotid Angioplasty or Vertebral Angioplasty, is a procedure that opens clogged arteries to restore the blood flow to your brain. The artery can be clogged with plaque (fat or calcium deposits), reducing the supply of oxygen-rich blood to the brain, a condition known as carotid artery disease.

During the procedure, the surgeon inserts and inflates a tiny balloon in the clogged artery to open up the narrowed area. Cerebral angioplasty is often combined with stenting, which involves placing a stent (small metal coil) in the clogged artery. 

Procedure Name	Cerebral Angioplasty
Alternative Name	Carotid Angioplasty or Vertebral Angioplasty
Conditions Treated	Atherosclerosis, Coronary artery disease
Benefits of Surgery	Less Invasive, Less Recovery Time, Low Risk of stroke
Treated By	Interventional Neuroradiologist or Vascular Surgeon

1. There are two carotid arteries and two vertebral arteries - one each on either side of the neck. 
2. They are responsible for supplying oxygen-rich blood to the brain and head. 
3. The right carotid artery extends up the neck. It arises from the innominate artery, originating from the aorta - the main vessel in the body that carries blood from the heart. 
4. The left carotid artery arises directly off the aorta. 
5. Each carotid artery branches off into internal and external carotid arteries.  
6. The internal carotid artery carries blood to the brain. 
7. The external carotid artery is further divided into seven branches which supply blood to the face, head, and neck. 
8. The vertebral arteries arise from the subclavian arteries, travel within the formamen in the cervical vertebra and supply the brain stem, cerebellum and the occipital lobes of the cerebrum.
9. A blockage in the carotid artery or vertebral artery due to plaque buildup can reduce blood flow to the brain, leading to a stroke. 

Similar to a common cardiology technique, cerebral angioplasty is performed on the brain to open partially blocked vertebral and carotid arteries in the neck as well as blood vessels within the brain.

Conditions that are treated with Cerebral Angioplasty include:

1. Atherosclerosis
2. Coronary Artery Disease

Cerebral angioplasty may be an appropriate treatment if:

1. You have a carotid artery blockage of 70% or more 
2. You had a stroke or other health conditions such as severe heart or lung disease
3. You already had a carotid endarterectomy and are experiencing restenosis (re-narrowing of the artery after surgery)
4. The location of the stenosis (narrowing) is difficult to access with carotid endarterectomy.
5. Repeated attacks of syncope, which ultimately leads to a major stroke 

Generally, a cerebral angioplasty procedure includes the following steps:

1. Step 1: Inserting a catheter into the artery
   The doctor places a small tube (sheath) into the artery through a small incision in a blood vessel in your groin. He/she then uses X-ray guidance to thread a catheter, with a balloon at its tip, through the sheath to the narrowing in the carotid artery / vertebral artery.
2. Step 2: Injecting a contrast material into the carotid artery
   The doctor injects contrast material into the carotid artery through the catheter. It may cause temporary warmth on one side of your face. Contrast material offers a detailed view of the blocked carotid artery and the blood flow to the brain. 
3. Step 3: Placing a filter in the artery
   The doctor inserts a filter known as an embolic protection device beyond the narrowing. The device filters any debris that may break off from the narrowed area of the carotid artery during the procedure. 
4. Step 4: Inflating the balloon
   Once the filter is in place, the doctor guides the balloon tip of the catheter to the area of the blockage. Next, he/she inflates the balloon to push the fatty plaque against the artery walls and widen the blood vessel, increasing the blood flow. 
5. Step 5: Placing the stent
   The doctor places a stent (a small metal mesh tube) in the newly opened artery to prevent it from narrowing again (restenosis). The stent helps keep the artery open. After stent placement, the doctor may perform an angiogram to confirm that the stent has completely expanded and the narrowing in the artery has been corrected. 
6. Step 6: Removing the balloon and catheter
   Once the procedure is completed, the doctor removes the sheath, catheter, balloon, and filter. The doctor applies pressure to the catheter insertion site to prevent bleeding. He/she then applies a bandage to cover the incision site. You may generally not need stitches after the procedure. 

You will have a consultation appointment with an anaesthesiologist to discuss sedation. 

1. Your doctor will review your medical history and conduct a physical exam. 
2. They will ask you about the medicines you take. 
3. Before the procedure, you may need to stop taking certain medications, such as blood thinners. 
4. You can take approved medications with small sips of water. 
5. If you smoke, the doctor may ask you to stop smoking. 
6. The doctor may perform specific tests before the procedure, including:-
7. Ultrasound to produce images of the narrowed carotid artery and the blood flow to the brain
8. Blood tests to check for infection
9. Computed tomography angiography (CTA) to produce highly detailed images of blood vessels
10. An electrocardiogram (ECG) to examine the heart rhythm
11. Carotid angiography to examine the blood vessels using X-rays with contrast material
12. A chest X-ray to view your lungs and heart
13. Inform your doctor if you are pregnant or might be pregnant.
14. Let your doctor know if you have had any recent health changes, such as a cold, fever, or other illness. 
15. The team will ask you to stop eating or drinking anything after midnight the night before the procedure. 
16. The doctor will briefly explain the procedure, estimated cost, duration of hospital stay, and insurance formalities. 
17. They will also discuss the types of stents and which one is better. 

What Can You Expect on the Day of the Procedure?

1. You need to sign a consent form, giving your permission for the procedure. 
2. The team will ask you to change into a hospital gown and remove all jewellery pieces. 
3. Someone from the nursing team will shave the excess hair in the incision area. 
4. The doctor will record your last meal. 
5. They will give you medication to be taken with a small sip of water.
6. The anaesthesiologist will monitor your vitals, such as breathing, heart rate, and blood pressure. 
7. The team will shift you to the laboratory procedure room. 

What Can You Expect During the Procedure?

1. In the procedure room, you will lie on the operating table. 
2. The team will start an IV line in your arms or hands for fluids and medications. 
3. You will receive sedation through the IV line to make you feel relaxed and sleepy during the procedure. 
4. The medical team will clean the surgical site with an antiseptic solution and place a sterile drape. 
5. The anaesthesiologist will inject local anaesthesia into your groin to numb the area. 
6. He/she will place small electrode pads on your chest to monitor your heart rate and rhythm during the procedure. 
7. Your doctor will make a small puncture or incision in the blood vessel in your groin and perform the procedure. 
8. Once the procedure is completed, he/she will apply pressure to the surgical site and a sterile bandage over the wound.

In the hospital

1. After the procedure, the team will shift you to the recovery room. 
2. You may feel confused when you wake up. 
3. The anaesthesiologist will monitor your vitals, including breathing and heart rate. 
4. You may receive pain medications to manage pain. 
5. You will need to lie flat (without bending your legs) for several hours to prevent bleeding from the incision site. 
6. The doctor will undergo an ultrasound of your carotid artery to evaluate the results. 
7. You can go home the same day or may have to stay overnight in the hospital. 
8. Your doctor will provide home care and follow-up instructions. 
9. You will need a friend or relative to drive you home. 

At home

1. Avoid engaging in strenuous activities and heavy lifting for 24 hours after the procedure. 
2. You may experience swelling, tenderness, and bruising at the incision site for a few days. 
3. There might be discolouration or a small lump in the incision area. 
4. Your doctor might recommend Tylenol or other medications to manage discomfort.
5. He/she may also prescribe medications to prevent blood clots and spasms of blood vessels. 
6. You may climb the stairs, but use a slower pace for the first few days. 
7. Do not strain during bowel movements. 

First Follow-Up Appointment

1. Your doctor will schedule the first follow-up appointment 4-6 weeks after the procedure.
2. During the visit, you may need to undergo an ultrasound.
3. The doctor will inspect the surgical site to ensure that it is healing properly. He/she will also discuss your continued care, including ways to lower the risk of restenosis. 

1. It offers a less invasive approach than carotid endarterectomy, the traditional surgery for treating blocked carotid arteries. 
2. It can be performed while the patient stays awake. As a result, it reduces the recovery time. 
3. It restores the blood flow through the previously blocked carotid artery, reducing the risk of stroke.

The side effects of the procedure include:

1. Infection
2. Heavy bleeding
3. Allergy to contrast material

The complications of cerebral angioplasty include:

1. Stroke
2. Artery injury
3. Kidney damage
4. Heart attack
5. Blood clots
6. Heart arrhythmia
7. Restenosis 
8. If the complications of cerebral angioplasty are not treated in time, they can be fatal. 

When to Consult a Doctor?

Call your healthcare professional if you experience:

1. Fever
2. Worsening pain or swelling at the incision site
3. Blood or fluid leakage from the incision site
4. Warmth or redness at the incision site
5. Chest pain

What is Restenosis?
Restenosis refers to a return of blockage or a re-narrowing of the treated carotid artery. It is caused by scar tissue accumulation at the treatment site. If you experience symptoms similar to before the procedure, consult your healthcare professional immediately. 

If a cerebral angioplasty is delayed, carotid artery disease can lead to a stroke. It is an emergency that can cause permanent brain damage and muscle weakness. In severe cases, a stroke can even cause death.

The cost of Cerebral Angioplasty ranges from ₹1,00,000 to ₹1,80,000. The cost varies based on the following factors:

1. Type of surgery
2. Age of the patient
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.

Procedure Name	Cost Value
Cerebral Angioplasty	₹1,00,000 to ₹1,80,000