Carotid angioplasty and stenting

Carotid angioplasty (kuh-ROT-id AN-jee-o-plas-tee) and stenting are procedures that open clogged arteries to restore blood flow to the brain. They're often performed to treat or prevent strokes. The carotid arteries are located on each side of your neck. These are the main arteries supplying blood to your brain. They can be clogged with fatty deposits (plaque) that slow or block blood flow to the brain — a condition known as carotid artery disease — which can lead to a stroke.

Carotid angioplasty and stenting may be appropriate stroke treatments or stroke-prevention options if: You have a carotid artery with a blockage of 70% or more, especially if you've had a stroke or stroke symptoms, and you aren't in good enough health to undergo surgery — for example, if you have severe heart or lung disease or had radiation for neck tumors You have already had a carotid endarterectomy and are experiencing new narrowing after surgery (restenosis) The location of the narrowing (stenosis) is difficult to access with endarterectomy In some cases, carotid endarterectomy may be a better choice than angioplasty and stenting to remove the buildup of fatty deposits (plaque) clogging the artery. You and your doctor will discuss which procedure is safest for you.

With any medical procedure, complications might happen. Here are some of the possible complications of carotid angioplasty and stenting: Stroke or ministroke (transient ischemic attack, or TIA). During angioplasty, blood clots that may form can break loose and travel to your brain. You'll receive blood thinners during the procedure to reduce this risk. A stroke can also occur if plaque in your artery is dislodged when the catheters are being threaded through the blood vessels. New narrowing of the carotid artery (restenosis). A major drawback of carotid angioplasty is the chance that your artery will narrow again within months of the procedure. Special drug-coated stents have been developed to reduce the risk of restenosis. Medications are prescribed after the procedure to decrease the risk of restenosis. Blood clots. Blood clots can form within stents even weeks or months after angioplasty. These clots may cause a stroke or death. It's important to take aspirin, clopidogrel (Plavix) and other medications exactly as prescribed to decrease the chance of clots forming in your stent. Bleeding. You may have bleeding at the site in your groin or wrist where catheters were inserted. Usually this may cause a bruise, but sometimes serious bleeding occurs and may require a blood transfusion or surgical procedures.

Before a scheduled angioplasty, your doctor reviews your medical history and performs a physical exam. You may also have one or more of the following examinations: Ultrasound. A scanner passes over the carotid artery to produce images using sound waves of the narrowed artery and of the blood flow to the brain. Magnetic resonance angiography (MRA) or computerized tomography angiography (CTA). These exams provide highly detailed images of blood vessels by using either radiofrequency waves in a magnetic field or by using X-rays with contrast material. Carotid angiography. During this exam, contrast material (visible on X-rays) is injected into an artery to better see and examine the blood vessels.

Carotid angioplasty is considered a nonsurgical procedure because it's less invasive than surgery. Your body isn't cut open except for a very small nick in a blood vessel in your groin. Most people don't need general anesthesia and stay awake during the procedure. However, some people may not stay awake based on their anesthesia and how sleepy they feel. You'll receive fluids and medications through an IV catheter to help you relax.