Carotid Angioplasty and Stenting
What is carotid angioplasty and stenting?
Angioplasty and stenting is a 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. 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. It's not surgery.
During the procedure, a thin flexible tube (cather) is put into an artery in your
groin. It is 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 part
of your carotid, the balloon is inflated. This opens up the narrowed area. This is
A tiny mesh tube (stent) may be put into this area. It's 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 (atherosclerosis). Certain things can raise
your risk for carotid stenosis. These include smoking, high blood pressure, high cholesterol,
diabetes, and aging.
Some people have symptoms from their carotid artery stenosis. These can include vision
problems or loss of nerve function in a certain part of the body. There is also a
risk that a blood clot can form in the narrowed 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 for 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 (transient ischemic attack or 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
cut (incision). Because of this, you may recover faster. It also prevents 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:
Allergic reaction to contrast material
Stroke at the time of the procedure or after.
Sudden vessel closure
Low blood pressure
Heart arrhythmias, such as a slow heart rate
Return of the blockage
Blood clot in your groin at the site where the catheter was put in.
Your risks may vary based on your overall health, the severity of your condition,
and other things. 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 health conditions such as diabetes
Ask your doctor about which risks apply most to you.
How do I get ready 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. These may include:
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
CT angiogram of the blood vessels of the neck and head
Before the procedure, 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 IV (intravenous) contrast dye
Have ever had a problem with sedation
Follow any directions you are given for not eating or drinking before surgery. Your
healthcare provider may give you other instructions on 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 special 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
medicine (sedation) through the IV line. This will make you relaxed and sleepy during
The healthcare team may remove hair in the area of your procedure. The area may be
numbed with a medicine (local anesthesia).
The doctor will make a small cut (incision) in a blood vessel in your groin. He or
she will then put a long, thin wire into this cut. The wire acts as a guide during
The doctor will then put 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. The doctor may use X-ray
images 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 (stent) may be left in place in the area. This will help keep the area
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 heart rate, breathing,
and other vital signs. 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 put in. You can take over-the-counter pain medicine if you need to. Get some rest
and don't do 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 (usually your groin)
Redness or warmth at the incision site
Weakness on side of your body, or trouble speaking or understanding what others say
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.
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