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This short animation shows how a carotid angioplasty and stenting procedure can open blocked arteries in the neck and restore blood flow to the brain, potentially preventing a stroke.
You may have heard of balloon angioplasty and stenting as a treatment for heart disease. This treatment is also used in place of surgery for carotid artery disease – blockages or narrowing in the arteries in the neck that supply blood to the brain. Today, carotid angioplasty and stenting is used with similar efficacy and safety as surgical carotid endarterectomy.
How Does Carotid Angioplasty and Stenting Work?
If diagnostic tests have revealed that you have a serious blockage in a carotid artery that can be treated without surgery, you may be treated with carotid angioplasty and stenting. The procedure is performed by a doctor with special training in catheter-based therapies, such as an interventional cardiologist, interventional radiologist or interventional vascular surgeon.
Carotid artery disease is a disease process where a fatty substance called plaque builds up in the arteries and can narrow them or lead to blockages. Carotid angioplasty and stenting works by reopening a blockage in the carotid arteries through use of a thin tube called a catheter and then propping the affected artery open with a mesh tube called a stent.
What Can You Expect Before the Procedure?
Members of your care team will give you instructions about what to expect on the day of the procedure, including food and drink restrictions and guidance on any medications you should stop or start in advance of the procedure. Carotid angioplasty and stenting is performed in a hospital’s catheterization laboratory, or “cath lab.” You will be awake during the procedure, but you will be given local anesthesia to numb the catheter insertion site, and you will also be given medications to relax you.
What Can You Expect During the Procedure?
During angioplasty, a thin tube (the catheter)is inserted into an artery, usually near the groin, and threaded up to the carotid arteries in the neck where the blockage is. This is accomplished with the guidance of live x-ray imaging. A small balloon is inflated to push the plaque to the sides of the artery wall and expand the artery. When the balloon opens, plaque and other debris may break free. This debris is caught by a tiny umbrella-like device (called a distal protection device) to greatly reduce the risk of stroke during the procedure. Then, the physician will often place a stent to help keep the artery from renarrowing.
The procedure typically takes about 2 hours, though preparation time will add to that length. The interventional cardiologist may talk with you during the procedure to help monitor blood flow to the brain.
What Can You Expect After the Procedure?
Patients usually stay in the hospital for up to 2 days after a carotid angioplasty and stenting procedure. This time in the hospital allows recovery time and lets the physician monitor progress.
Patients are discharged with information about what activities they may need to limit and for how long. For example, you may be asked to limit lifting objects and avoid all strenuous physical activity for 24 hours.
Your care team will notify you of warning signs that you should contact them, such as the following:
- Symptoms of a stroke, such as confusion and difficulty speaking or understanding speech, or numbness or weakness of the face or limbs on one side of the body
- Changes to the puncture wound in your leg, such as increased redness, drainage or pain at the site when no pressure is applied
- Swelling in the leg in which the catheter was inserted
Does Carotid Angioplasty and Stenting Carry Risks?
Like all medical procedures, carotid angioplasty and stenting carries some risks. Serious complications are rare, and the risks of the procedure are usually lower than those of not being treated for carotid artery disease. Talk with your physician about risks. Some risks include:
- Bleeding at the catheter insertion site
- Reblockage of the artery due to a clot in the stent (restenosis)
- Kidney damage from dye used for x-rays (this more likely for patients who already have kidney disease)
Long-Term Recovery After Carotid Angioplasty and Stenting
Your recovery from the actual carotid angioplasty and stenting procedure will typically be brief, but it is only the beginning of the process of preventing a future stroke, heart attack or other forms of cardiovascular disease. Lifestyle changes and taking medications exactly as prescribed by your physician can help slow, halt or reverse the underlying disease process that caused blockages in your carotid arteries and that affects all arteries throughout your body.
Questions to Ask Your Doctor About Carotid Angioplasty and Stenting
You may wish to use the following questions as a tool to help you talk to your physician about carotid angioplasty and stenting. We invite you to print them and take them with you to your next appointment. Taking notes will help you remember your discussion when you get home.
- Based on my risk factors, medical history and the severity and location of the blockages in my carotid arteries, what is the best treatment for me?
- What will I need to do in the weeks, hours and days leading up to the procedure? Are there tests that I will need to undergo?
- What else can I do to prepare for the procedure so that I have the best chance for a successful procedure and recovery?
- How long will I be in the hospital?
- Considering my history, do you have concerns about complications?
- How long will it be until I can return to work or other normal daily activities?
- How will I feel after recovery is complete?
- Will my arteries re-narrow or become blocked again? If so, in what time period should I expect this to happen?
- What kind of care is necessary and ongoing after the procedure? Do I have to keep taking medications? What kind and why?
- Can I get help with making lifestyle changes, such as quitting smoking, adopting a healthy diet and exercising?
You may also have questions about why your physician may recommend either carotid angioplasty and stenting or carotid endarterectomy. This decision will be individualized to the severity and location of your blockages, your medical history and your risk factors. To learn about both treatment options, click here.
If you are scheduled to undergo carotid angioplasty and stenting, it can be helpful to know who the medical professionals are who will treat you along the way. Click here to learn more about your care team during carotid angioplasty and stenting.