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Carotid Stenting Preparation at IRFacilities
At IRFacilities, patient comfort, safety, and meticulous preparation are at the forefront of every carotid stenting procedure. Our team, led by the senior IR, ensures that each step prior to the procedure is carefully managed to provide the best possible experience and outcomes for our patients. Here’s how we prepare for carotid stenting, starting one hour before the procedure.
Patient Relaxation and Consultation
To ease pre-procedure anxiety, the patient is given 0.5 mg of clonazepam. A brief and reassuring discussion follows, addressing any last-minute concerns and ensuring the patient feels calm and confident. The patient is then escorted to the CATH-LAB by familiar and trusted staff members, enhancing their sense of comfort and security.
Seamless Transfer to CATH-LAB
Upon arrival at the CATH-LAB, the patient is meticulously transferred to the procedure table. Every effort is made to ensure a painless experience when securing IV lines, a critical step in the preparation process.
Vital Checks and Medication Review
Our team confirms that the patient has taken prescribed antiplatelet medications and lipid-lowering drugs, such as atorvastatin. Vital signs, including blood pressure and heart rate, are thoroughly checked to ensure stability. A radial line is placed, preferably in the left hand, to enable continuous blood pressure monitoring.
Ensuring Patient Comfort and Confidence
Before proceeding, the patient is asked again if they feel comfortable and confident. We believe clear communication and reassurance are essential to their well-being.
Urinary Catheter Placement (If Needed)
For shorter procedures, a Foley catheter is usually avoided. However, for longer procedures, a catheter is placed to ensure uninterrupted care. This step is carefully considered based on the procedure duration and the patient’s comfort.
Final Check and senior IRs visit
Once the preparatory steps are completed, Doctor meets the patient personally to provide reassurance and address any last-minute concerns. Only after the patient confirms they are ready does the actual procedure begin, starting with the puncture of the femoral artery.
At IR Facilities, we take pride in delivering patient-centric care and ensuring that every procedure is carried out with precision, professionalism, and compassion. Trust us for your interventional radiology needs, where every detail matters.
Actual Carotid Stenting Procedure at IR Facilities
Below is an overview of the procedure as it unfolds on the table:
Patient Preparation and Monitoring
The patient is carefully prepped and placed on the procedure table under monitored anesthesia care or light sedation. A radial arterial line is established to continuously monitor critical parameters such as:
- Heart rate
- Blood pressure
- Oxygen saturation
This ensures real-time tracking of the patient’s vital signs throughout the procedure.
Access and Initial Catheterization
A femoral arterial access is achieved using an 8-Fr access sheath. This provides a stable entry point for the subsequent catheter and wire exchanges. The procedure begins with the insertion of a Picard catheter, a 5-Fr diagnostic catheter, into the femoral access. The Picard is skillfully navigated to the common carotid artery (CCA) level, ensuring accurate positioning for further steps.
Guidewire Exchange and Catheter Upgrade
Once the diagnostic phase is complete, an exchange wire is introduced through the Picard catheter. This wire allows for the replacement of the Picard with a more robust 8-8 guiding catheter or a long sheath. This upgrade is crucial for ensuring sufficient support and control during the deployment of the carotid stent. The use of advanced diagnostic and guiding catheters ensures precise access to the carotid artery, minimizing risks and enhancing the procedural outcome. The exchange wire technique enables seamless transitions between catheters, reducing procedural time while maintaining stability.
Using the Long Sheath for Assessment
Once the long sheath is in place, it is utilized to perform a diagnostic angiographic run. This is done in the ipsilateral oblique caudal view, which provides a detailed visualization of:
The stenosis and its characteristics
The intracranial circulation, ensuring no additional concerns exist in distal segments. The O88 sheath is carefully positioned at the most stable location within the vascular system. Importantly, it is not placed based on the anticipated stent landing zone. This approach ensures procedural stability, as the sheath can later be repositioned or withdrawn after partial stent deployment, if required.
Road Map Guidance and Protection Filter Placement
After the sheath is positioned, a road map angiogram is obtained to guide the next steps. Using this live imaging technique: A protection filter device is carefully negotiated through the stenosis into the distal cervical internal carotid artery (ICA). This device safeguards against embolic events by capturing dislodged plaque fragments during stenting.
Managing Stenosis or Spasms
While advancing the filter device, the interventional radiologist may encounter stenosis-related challenges or arterial spasms. These are managed effectively with:
Nitroglycerin (NTG): A 100-microgram dose of NTG is administered to relax the vessel and alleviate spasms.
Dynamic Road Mapping for Patient Comfort
Special care is taken to minimize patient discomfort and motion during the procedure:
The road map imaging is toggled on and off as needed, ensuring the patient can remain still during critical moments without prolonged imaging exposure.
Assessing the Need for Pre-Dilation
Once the protection filter device is securely in place, the interventional team evaluates whether pre-dilation of the stenosis is necessary. This decision is based on:
- The severity of the stenosis.
- The stability of the filter device.
- The feasibility of direct stent placement without pre-dilation.
Here’s a step-by-step explanation of the procedure, optimized for clarity and detail.
Pre-Dilation (If Required)
Pre-dilation is a critical step to ensure the carotid stent is optimally deployed. At IR Facilities, this is approached with care:
- A 3 mm or 4.5 mm balloon is used for pre-dilation.
- Balanced Approach: While we avoid aggressive pre-dilation, we also ensure it is substantial enough to facilitate stent placement.
- The pre-dilation balloon is a rapid exchange system, allowing for quick removal after use.
- During this phase, continuous monitoring of the patient’s vitals is essential.
- Bradycardia and hypertension are closely watched.
- Atropine is prepared and administered promptly if bradycardia occurs, ensuring the patient’s safety.
Stent Deployment
After pre-dilation, the stent is deployed using a rapid exchange system. The most commonly used stents are:
- 8-6-40 mm
- 9-7-40 mm
These stents are carefully selected based on the patient’s vascular anatomy and stenosis characteristics.

Stent Deployment
After pre-dilation, the stent is deployed using a rapid exchange system. The most commonly used stents are:
- 8-6-40 mm
- 9-7-40 mm
These stents are carefully selected based on the patient’s vascular anatomy and stenosis characteristics.
Post-Dilation
Once the stent is deployed, a post-dilation step is carried out to ensure it is optimally positioned and expanded:
- Larger balloons, typically 4.5 mm, 5 mm, or 6 mm in diameter, are used.
- Monitoring continues to detect any signs of bradycardia or hypotension.
- Atropine is administered if bradycardia falls below the patient-specific threshold.
- The balloon is then removed, and a retrieval device is prepared for the next step.
Filter Retrieval and Final Assessment
With the stent in place, attention shifts to the protection filter device:
- The retrieval device is passed through the stent over the filter wire to capture and remove the filter.
- A diagnostic angiographic run is performed to confirm the integrity of the intracranial circulation and the absence of complications.
Patient Monitoring and Sheath Removal
Once the intracranial circulation is confirmed and no issues are detected:
- The patient’s ability to follow commands is assessed to rule out any new neurological deficits.
- The long sheath is removed, followed by the groin sheath.
- To promote hemostasis and early mobility.
- A Perclose suture device is often used to secure the femoral access site.
- Patients are advised to keep their leg straight for six hours to minimize the risk of bleeding or pseudoaneurysm formation.
Immediate Post-Procedure Care
After the procedure, the patient is monitored closely to ensure stability:
- Vital signs are continuously checked.
- The patient is assessed for any discomfort or complications.
Leading Core
Our Team
Leading Team of Core Neuroradiologists & Interventional Radiologists of the Region.

Dr. SANDEEP SHARMA
(MD, DM Neuro Radiology AIIMS)

Dr. LOKESH SINGH
(Ex. AIIMS, PGIMER)

Dr. GAURAV DHAWAN
(Ex. TMH, SGRH)

Dr. JASPREET SINGH
(Ex. SSCHRC Bangalore)