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Angioplasty and stent placement - carotid artery

Carotid angioplasty and stenting; CAS; Angioplasty - carotid artery; Carotid artery stenosis - angioplasty

The blood vessels that bring blood to your brain and face are called the carotid arteries. You have a carotid artery on each side of your neck.

The blood flow in this artery can become partly or totally blocked by fatty material called plaque. A partial blockage is called carotid artery stenosis (narrowing). A blockage in your carotid artery can reduce the blood supply to your brain. Sometimes part of a plaque can break off, travel downstream and block a brain artery. A stroke can occur if your brain does not get enough blood.

Two procedures can be used to treat a carotid artery that is narrowed or blocked. These are:

Images

Atherosclerosis of internal carotid artery
Carotid stenosis - X-ray of the right artery
Cholesterol producers

Description

Carotid artery angioplasty and stenting (CAS) is done using a small surgical cut.

Why the Procedure Is Performed

Carotid artery surgery (endarterectomy) is a well-established and effective way to treat narrowed or blocked arteries. This procedure is very safe.

CAS has developed as a good alternative to surgery in some cases, when done by experienced surgeons. Certain factors may favor stenting, such as:

Risks

Risks of CAS, which depend on factors such as age, are:

Before the Procedure

Your health care provider will do a physical exam and perform several medical tests.

Always tell your provider what medicines you are taking, including drugs, supplements, or herbs you bought without a prescription.

During the 2 weeks before your procedure:

DO NOT drink anything after midnight the night before your surgery, including water.

On the day of your surgery:

After the Procedure

After surgery, you may need to stay in the hospital overnight so that you can be watched for any signs of bleeding, stroke, or poor blood flow to your brain. You may be able to go home the same day if your procedure is done early in the day and you are doing well. Your provider will talk to you about how to care for yourself at home.

Outlook (Prognosis)

Carotid artery angioplasty and stenting may help lower your chance of having a stroke. But you may need to make lifestyle changes, such as change in diet and regular exercise, to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. In addition, your provider will recommend medicines to further reduce your chance of a stroke.

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References

Deery SE, Hicks CW. Carotid artery stenting. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 94.

Hassani S, Fisher M. Management of atherosclerotic carotid artery disease: a brief overview and update. Am J Med. 2022;135(4):430-434. PMID: 34732352 pubmed.ncbi.nlm.nih.gov/34732352/.

Kinlay S, Bhatt DL. Treatment of noncoronary obstructive vascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 44.

Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467. PMID: 34024117 pubmed.ncbi.nlm.nih.gov/34024117/.

Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 2016;374(11):1011-1020. PMID: 26886419 pubmed.ncbi.nlm.nih.gov/26886419/.

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Review Date: 1/18/2023  

Reviewed By: Luc Jasmin, MD, Ph.D., FRCS (C), FACS, Department of Surgery, Johnson City Medical Center, TN; Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Internal review and update on 02/23/24 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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