Carotid Artery Stenting

Treatment Overview

Carotid artery stenting (CAS) is a procedure that can be used to open narrowed carotid arteries. It is also called carotid angioplasty and stenting.

There are two carotid arteries—one on each side of the neck—that supply blood to the brain. Fatty buildup (plaque) can narrow or block these arteries (stenosis). When one or both of your carotid arteries are narrowed, it can make it hard for blood to flow to the brain. Carotid artery stenting may improve blood flow to your brain and lower your risk of having a stroke.

During carotid artery stenting, a small, expandable tube called a stent is permanently inserted into the carotid artery.

To insert the stent, the doctor uses another tube called a catheter. The doctor inserts the catheter into a large artery—most often the femoral artery in the groin—and threads it through other arteries to the carotid artery. The doctor will put dye into the catheter. The dye will make your carotid artery show up on X-ray images so that the doctor can find the blocked section of the artery.

A very thin guide wire is inside the catheter. The guide wire is used to move a balloon and the stent into the carotid artery. The balloon is placed inside the stent and inflated. This opens the stent and pushes it into place against the artery wall. The balloon is then deflated and removed, leaving the stent in place. After time, the cells lining the blood vessel will grow through and around the stent to help hold it in place.

Stenting should:

  • Open up the artery and press the plaque against the artery walls, improving blood flow.
  • Keep the artery open after the balloon is deflated and removed.
  • Seal any tears in the artery wall.
  • Prevent the artery wall from collapsing or closing off again (restenosis).
  • Prevent small pieces of plaque from breaking off, which might cause a stroke.

The procedure usually takes about 1 to 2 hours.

What To Expect After Treatment

After the procedure, you will be moved to a recovery room. Your heart rate, pulse, and blood pressure will be closely monitored. The place where the catheter was put in (catheter insertion site) will be checked for bleeding. You may have a large bandage or a compression device on your groin at the catheter insertion site to prevent bleeding. You will be told to keep your leg straight.

You may need to stay in the hospital for 1 or 2 days after the procedure.

After you leave the hospital, you may notice a bruise or small lump where the catheter was put in. The area may feel sore and the bruise may get bigger for a few days after the procedure. You can do light activities around the house but nothing strenuous for 1 to 2 weeks.

You will take antiplatelet medicines to help prevent a stroke. You will still need to make lifestyle changes like eating healthy, being active, and not smoking. This will give you the best chance for a longer, healthier life.

Why It Is Done

Carotid artery stenting is done to lower your risk of stroke or transient ischemic attack (TIA).

Your doctor may suggest that you have carotid artery stenting if:1

  • You have had a mild stroke or one or more transient ischemic attacks (TIAs) in the past 6 months and your carotid artery is narrowed by 70% or more.
  • You have a low risk for having problems (complications) from the procedure.
  • You have a high risk of complications from carotid artery surgery (carotid endarterectomy).

How Well It Works

Carotid artery stenting may work as well as surgery to prevent stroke and other problems in some people who have narrowed carotid arteries.2, 3 Talk with your doctor about whether stenting is an option for you.

Risks

The major risks associated with carotid artery stenting are:

  • Stroke.
  • Heart attack.
  • Bleeding at the catheter insertion site.
  • Damage to the blood vessel at the catheter insertion site.
  • Infection.
  • Death.

Carotid artery stenting is not a good choice for people older than age 70. Studies have shown that for people in this age group, the risk of stroke or death during the procedure is too high. Carotid endarterectomy is safer for people older than 70.

What To Think About

The decision about whether to have carotid artery stenting, have carotid endarterectomy, or take medicine is different for every person. It's important to talk with your doctor about your individual risks and your options.

For more information about making the decision to have surgery, see:

Click here to view a Decision Point.Stroke: Should I Have Carotid Endarterectomy?

Several things affect whether carotid artery stenting is more effective than treatment with medicine. One important factor is the skill of the surgeon. Research suggests that the surgeon doing the carotid artery stenting should have a low complication rate in order for the procedure to be considered beneficial for his or her patients. The American Heart Association recommends a complication rate less than 6% for carotid artery stenting. Complication rates higher than 6% negate the potential benefit of stroke risk reduction. In other words, if the surgeon's complication rate is higher than 6%, you are more likely to have complications from the surgery than to benefit from long-term reduction in your risk for stroke.1

To find your surgeon's complication rate, check with his or her office, the hospital where the surgery will be done, and your state's medical association. Access to this information may vary by state.

Another way to measure how much carotid artery stenting may reduce your risk of stroke compared to medicine is by looking at the experience of the hospital staff with this procedure. In general, larger hospitals and regional medical centers have staffs that are more experienced in doing carotid artery stenting than staffs in smaller hospitals. Check to see how many procedures are done in your hospital each year.

Other things that affect how successful carotid artery stenting may be are your age, gender, other health problems, and how severe your first TIA or stroke was.

Complete the special treatment information form (PDF)special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.

References

Citations

  1. Furie KL, et al (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(1): 227–276. Also available online: http://stroke.ahajournals.org/content/42/1/227.full.
  2. Brott TG, et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. The New England Journal of Medicine, 363(1): 11–23.
  3. International Carotid Stenting Study Investigators (2010). Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): An interim analysis of a randomised controlled trial. Lancet, 375(9719): 985–997.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Karin M. Lindholm, DO - Neurology
Last Revised January 3, 2013

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