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Angioplasty and stent placement - carotid artery


Alternative Names:

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

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.

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

  • The person is too ill to have carotid endarterectomy.
  • The location of the narrowing in the carotid artery makes surgery harder.
  • The person has had neck or carotid surgery in the past.
  • The person has had radiation to the neck.
Risks:

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

  • Allergic reaction to dye
  • Blood clots or bleeding at the site of surgery
  • Brain damage
  • Clogging of the inside of the stent (in-stent restenosis)
  • Heart attack
  • Kidney failure (higher risk in people who already have kidney problems)
  • More blockage of the carotid artery over time
  • Seizures (this is rare)
  • Stroke
Before the Procedure:

Your health care 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:

  • Days before the surgery, you may have to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel (Effient) naprosyn (Aleve, Naproxen), and other drugs like these.
  • Ask your provider which drugs you should still take on the day of your surgery.
  • If you smoke, you need to stop. Ask your provider for help quitting.
  • Always let your provider know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

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

On the day of your surgery:

  • Take the drugs you have been told you to take with a small sip of water.
  • You will be told when to arrive at the hospital.
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 health care provider will talk to you about how to care for yourself at home.

References:

Amarenco P, Labreuche J, and Mazighi M: Lessons from carotid endarterectomy and stenting trials. Lancet. 2010;376(9746):1028-31. PMID: 20870079 www.ncbi.nlm.nih.gov/pubmed/20870079.

Brott TG, Halperin JL, 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. J Am Coll Cardiol. 2011. PMID: 23281092 www.ncbi.nlm.nih.gov/pubmed/23281092.

Brott TG, Hobson RW, Howard G, et al: Stenting versus endarterectomy for treatment of carotid-arery stenosis. N Engl J Med. 2010;363(1):11-23. PMID: 20505173 www.ncbi.nlm.nih.gov/pubmed/20505173.

Gurm HS, Yadav JS, Fayad P, et al: Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008;358(15):1572-9. PMID: 18403765 www.ncbi.nlm.nih.gov/pubmed/18403765.

Kinlay S, Bhatt DL. Treatment of noncoronary obstructive vascular disease. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 60.


Review Date: 4/20/2015
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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