Carotid Artery Stenting

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Treatment Overview

Carotid artery stenting (CAS) is a procedure that can be used to open a narrowed carotid artery. It involves placing a small, expandable tube called a stent in the narrowed artery. This procedure 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. These arteries can be narrowed and damaged by fatty deposits called plaque. If this plaque breaks open, it may form a blood clot, which could move to the brain and cause a stroke. Carotid artery stenting may improve blood flow to your brain and lower your risk of stroke.

During carotid artery stenting, the doctor uses a tube called a catheter to insert the stent. The doctor puts the catheter into a large artery—most often the femoral artery in the groin. Then he or she threads it through other arteries to the carotid artery. Dye is used to make your carotid artery show up on X-ray images. This helps the doctor find the narrowed part of the artery.

The doctor moves 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. Over time, the cells lining the blood vessel will grow through and around the stent to help hold it permanently in place.

Stenting can help:

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

What To Expect After Treatment

The procedure usually takes about 1 to 2 hours. 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 don't do anything 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 foods, 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 help lower your risk of stroke.

Your doctor may recommend this procedure based on certain things. These include:footnote 1, footnote 2

  • The amount of narrowing (stenosis) in your carotid arteries. A procedure may be an option if the narrowing is 50% or more.
  • Whether you had a stroke or TIA within the past 6 months. If you have not had a stroke or TIA, it is less clear that the procedure will help you.
  • Whether you have a low risk (less than 6%) of stroke or death from a procedure.

How Well It Works

If you have not had a TIA or stroke

For people who have not had a stroke or TIA, it is not as clear when stenting might be a good choice. Stenting may help prevent a stroke in the long run. But in the short run, it increases the risk of stroke and death. Medicine and lifestyle changes may work as well as stenting to prevent a stroke, and they don't have the risks of stenting.

Carotid artery stenting may be an option if you have more than 60% to 70% narrowing and you have a low risk of serious problems from stenting.footnote 1

It is not clear that stenting will reduce your stroke risk more than medicines and lifestyle changes alone. Studies are being done to compare current medical therapy with stenting.

If you have had a TIA or stroke

Carotid artery stenting can help lower your risk of stroke if your carotid artery is narrowed by 50% or more. footnote 2

You may benefit most from stenting if it is done within 2 weeks of the stroke or TIA. This is when the risk of stroke is highest.

Risks

The risks of carotid artery stenting include:

  • Infection.
  • Bleeding at the catheter insertion site.
  • Damage to the blood vessel at the catheter insertion site.
  • Stroke, heart attack, or death.

The risks of a procedure depend on things like your age and your overall health. Who does the procedure and where it is done are also important.

Carotid artery stenting is not a good choice for people older than age 70. For people in this age group, the risk of stroke or death during the procedure is too high. Carotid artery surgery (endarterectomy) is usually safer for people older than 70.footnote 3

What To Think About

The decision about whether to have a carotid artery procedure is different for every person. Your doctor can help you weigh the benefits and risks of these procedures and compare them with the benefits and risks of medical therapy.

Having a procedure does not take the place of medicines and a healthy lifestyle. If you decide to have the procedure, you will still need to take medicines and have healthy habits.

Stroke Prevention: Should I Have a Carotid Artery Procedure?
Carotid Artery Procedures After a Stroke or TIA

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References

Citations

  1. Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.
  2. Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.
  3. Bonati LH, et al. (2012). Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. Cochrane Database of Systematic Reviews (9). DOI: 10.1002/14651858.CD000515.pub4. Accessed September 12, 2014.

Other Works Consulted

  • Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.
  • Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.

Credits

ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerKarin M. Lindholm, DO - Neurology

Current as ofAugust 17, 2015