What is carotid angioplasty and stenting?

Angioplasty and stenting is a type of procedure to improve the blood flow in an artery or vein. The carotid artery is a large artery running along each side of your neck.

Carotid angioplasty and stenting involves the carotid artery. During the procedure, doctors use a thin tube with a balloon at its tip to open up the artery.

The carotid arteries send oxygen-rich blood to your brain. A condition called carotid artery stenosis means that one or both of these arteries are narrowed. And, blood flow to the brain is reduced. This can lead to stroke. Carotid angioplasty and stenting can help reopen these arteries. It is a minimally invasive procedure and nonsurgical.

During the procedure, a thin flexible tube (catheter) is put into an artery in your groin. It will be gently threaded up into the problem carotid artery in your neck. The catheter has a tiny deflated balloon at the tip. When it reaches the narrowed portion of your carotid, the balloon is inflated. This opens up the narrowed area. This is known as angioplasty.

A tiny mesh tube called a stent may be put into this area. It is left in place to help keep the artery open.

Why might I need carotid angioplasty and stenting?

You might need this procedure if you have carotid artery stenosis. This is a narrowing in one or both of the carotid arteries. Carotid stenosis is often caused by the buildup of plaque on the inside of the artery. This is known as atherosclerosis. Certain things can raise your risk of carotid stenosis. These include smoking, high blood pressure, high cholesterol, diabetes, obesity, and aging.

Some people have symptoms from their carotid artery stenosis. These can include vision problems or loss of neurologic function in a specific part of the body. There is also a risk that a blood clot can form in the narrowed carotid artery. If this blood clot travels to the brain, it can block the brain’s blood supply. This is called a stroke. It can cause serious harm to the brain and even death.

If you have mild carotid artery stenosis, your doctor may give you medicines to reduce your risk of stroke.

If you have more severe blockage, your doctor is more likely to advise a procedure to open the artery. Your doctor is also more likely to recommend a procedure if you have already had a stroke or mini-stroke. A mini-stroke is also known as a transient ischemic attack (TIA).

Carotid angioplasty and stenting is one option. Another is a surgery called carotid endarterectomy. This surgery removes plaque and any damaged part of the artery.

Carotid angioplasty and stenting is less invasive. This means it uses only a small incision. Because of this, it may lead to shorter recovery times. It also avoids the risks of general anesthesia. Talk with your doctor about the risks and benefits of each procedure for you.

What are the risks for carotid angioplasty and stenting?

The risks of this procedure include:

• Infection
• Heavy bleeding
• Artery injury
• Allergic reaction to contrast material
• Kidney damage
• Stroke
• Heart attack
• Sudden vessel closure
• Low blood pressure
• Heart arrhythmias, such as a slow heart rate
• Return of the blockage

Your risks may vary based on your overall health, the severity of your condition, and other factors. You may have an increased risk of complications if you:

• Have symptoms from your carotid stenosis
• Have had a stroke or mini-stroke
• Have other medical conditions, such as diabetes

Ask your doctor about which risks apply most to you.

How do I prepare for carotid angioplasty and stenting?

Talk with your healthcare provider how to prepare for your procedure. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your procedure. Talk with your healthcare provider if you need help to stop smoking.

You may need some tests before the procedure, such as:

• Blood tests, to check for anemia and infection
• An electrocardiogram (ECG), to check your heart rhythm
• A chest X-ray, to view your heart and lungs
• Ultrasound of your neck, to view the carotid artery
• Computed Tomography (CT) angiogram of the blood vessels of the neck and head

Before the procedure, make sure to tell the medical team if you:

• Have had any recent changes in your health, such as a fever
• Are pregnant or might be pregnant
• Are allergic to iodine
• Have ever had a bad reaction to intravenous contrast dye
• Have ever had a problem with sedation

Do not eat or drink after midnight the night before your procedure. Your healthcare provider may give you additional instructions about how to prepare.

What happens during carotid angioplasty and stenting?

Talk with your healthcare provider about what to expect during your procedure. The procedure will likely be done by a doctor trained in vascular medicine and a team of specialized nurses. A typical procedure may go like this:

• An IV will be put in your arm or hand before the procedure starts. You’ll be given sedation through the IV line. This will make you relaxed and sleepy during procedure.
• Hair in the area of your procedure may be removed. The area may be numbed with a local anesthesia.
• The doctor will make a small incision in a blood vessel in your groin. He or she will then insert a long, thin wire into this cut. The wire acts as a guide for during the procedure.
• The doctor will then insert a thin, flexible tube (catheter) over the wire. It has a tiny deflated balloon on the end. The catheter will be threaded through the blood vessel all the way into the carotid artery in your neck. Continuous X-ray images may be used to show exactly where the catheter is.
• The balloon will be inflated inside the narrow part of the carotid artery. This will stretch the area open.
• A mesh tube called a stent may be left in place in the area. This will help keep the area open.
• The balloon will be deflated, and the catheter will be removed.
• The incision site in the groin will be closed and bandaged.

What happens after carotid angioplasty and stenting?

After the procedure, you will spend several hours in a recovery room. You may be sleepy and confused when you wake up. Your healthcare team will watch your vital signs, such as your heart rate and breathing. You’ll be given pain medicine if you need it.

You may need to lie flat without bending your legs for several hours after the procedure. This is to help prevent bleeding from the incision site. You may be able to go home the same day. Or you may need to stay in the hospital overnight. Your doctor will tell you more about what to expect. When you’re ready to go home, you’ll need to have a family member or friend drive you.

You may have some pain after the procedure. You may notice a bruise where the catheter was inserted. You can take over-the-counter pain medicine if you need to. Get some rest and avoid strenuous exercise for at least 24 hours.

Call your healthcare provider right away if you have any of the following:

• Swelling or pain at the incision site that gets worse
• Fluid or blood leaking from the incision site
• Redness or warmth at the incision site
• Fever
• Chest pain

Follow all of your healthcare provider’s instructions. This includes any advice about medicines, exercise, and wound care.

Your doctor may prescribe medicine to help prevent blood clots or spasm of your blood vessels. You also might need follow-up lab work or imaging of the area.

If you had symptoms from your carotid stenosis, these should go away after the procedure. In follow-up appointments, you’ll need to discuss your continued care. This includes ways to lower your risk for atherosclerosis.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications are
• What would  happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure