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Angioplasty and stent placement - carotid artery

Carotid angioplasty and stenting; CAS; Angioplasty - carotid artery; Carotid artery stenosis - angioplasty

The blood vessels that bring blood to your brain and face are called the carotid arteries. You have a carotid artery on each side of your neck.

The blood flow in this artery can become partly or totally blocked by fatty material called plaque. A partial blockage is called carotid artery stenosis (narrowing). A blockage in your carotid artery can reduce the blood supply to your brain. Sometimes part of a plaque can break off and block off another artery. A stroke can occur if your brain does not get enough blood.

Two procedures can be used to treat a carotid artery that is narrowed or blocked. These are:

Images

Atherosclerosis of internal carotid artery
Carotid stenosis, X-ray of the right artery
Cholesterol producers

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Description

Carotid angioplasty and stenting (CAS) is done using a small surgical cut.

Why the Procedure Is Performed

Carotid surgery (endarterectomy) is an older and effective way to treat narrowed or blocked arteries. This procedure is very safe.

CAS has developed as a good alternative to surgery, when done by experienced operators. Certain factors may favor stenting, such as:

Risks

Risks of carotid angioplasty and stent placement, which depend on factors such as age, are:

Before the Procedure

Your provider will do a physical exam and perform several medical tests.

Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the 2 weeks before your procedure:

DO NOT drink anything after midnight the night before your surgery, including water.

On the day of your surgery:

After the Procedure

After surgery, you may need to stay in the hospital overnight so that you can be watched for any signs of bleeding, stroke, or poor blood flow to your brain. You may be able to go home the same day if your procedure is done early in the day and you are doing well. Your provider will talk to you about how to care for yourself at home.

Outlook (Prognosis)

Carotid artery angioplasty and stenting may help lower your chance of having a stroke. But you will need to make lifestyle changes to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. You may need to change your diet and start an exercise program if your provider tells you exercise is safe for you.

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References

Aboyans V, Ricco JB, Bartelink MEL, et al. Editor's choice - 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(3):305-368. PMID: 28851596 www.ncbi.nlm.nih.gov/pubmed/28851596.

Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. Catheter Cardiovasc Interv. 2013;81(1):E76-E123. PMID: 23281092 www.ncbi.nlm.nih.gov/pubmed/23281092.

Brott TG, Howard G, Roubin GS, et al. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021-1031. PMID: 26890472 www.ncbi.nlm.nih.gov/pubmed/26890472.

Hicks CW, Malas MB. Cerebrovascular disease: carotid artery stenting. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 92.

Kinlay S, Bhatt DL. Treatment of noncoronary obstructive vascular disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 66.

Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 2016;374(11):1011-1020. PMID: 26886419 www.ncbi.nlm.nih.gov/pubmed/26886419.

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Review Date: 2/22/2018  

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 03/28/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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