Carotid artery stenting

Carotid artery stenting is a procedure that can be used to open narrowed carotid arteries. This procedure is much like coronary angioplasty, which is commonly used to open blocked arteries in the heart. Its use in carotid arteries is relatively new but growing. The U.S. Food and Drug Administration (FDA) has approved its use in the treatment of people with severe carotid artery narrowing. It is performed at large, specialized medical centers.

During this procedure, a tube (catheter) is inserted through a large artery—most often the femoral artery in the groin—and threaded through other arteries to the carotid artery. After the catheter reaches the narrowed portion of the carotid artery, a small balloon at the end of the tube is inflated for a short period of time.

The pressure from the inflated balloon presses the plaque against the wall of the artery to improve blood flow. A stent (a metal tube) is placed in the artery to keep the plaque from tearing open and to keep the artery from closing. New crush-resistant stents with filters to catch clots have been developed. These new stents have solved problems seen with earlier stents.

The procedure takes about 1 hour. The person usually is awake during the procedure and feels little pain. Usually, hospitalization is needed for about 24 hours after the procedure, to watch for complications. So far, few problems have been encountered with this procedure.

Early studies show that carotid artery stenting holds promise and may be as effective as surgery (carotid endarterectomy) in people who are at high risk for stroke. Large-scale studies are being conducted to clarify when carotid stenting can be safely used.¹

This procedure may prevent a transient ischemic attack (TIA) and stroke in some people who have had a TIA or stroke caused by significant carotid hardening and narrowing (70% or more) and who are not good candidates for carotid endarterectomy surgery.