What is Carotid Artery Stenting?

D. Jeffress

The carotid arteries are the large blood vessels that supply the neck, face, and brain with new blood from the heart. If a carotid artery becomes clogged by plaque buildup or a blood clot, less blood makes it to the brain and the risk of stroke and sudden death is very high. Obstructions or narrowing of the carotid artery typically require surgery to prevent life-threatening complications. A common procedure called carotid artery stenting involves placing a metal tube inside the artery to hold the walls open and encourage better blood flow to the brain. The procedure has a high success rate, and patients who follow their doctors' instructions regarding lifestyle choices and medication use following surgery have very good chances of recovering.

A metal stent is put in place to reduce further cholesterol buildup in a blood vessel.
A metal stent is put in place to reduce further cholesterol buildup in a blood vessel.

Most cases of carotid artery disease are caused by buildups of cholesterol and triglycerides due to poor dietary choices and chronic conditions such as diabetes. Cholesterol slowly hardens in the artery and clings to the interior walls, which narrows the passageway between the heart and brain. Before the invention of carotid artery stenting, patients had to undergo open surgeries so plaque buildup could be manually scraped away. Such procedures are still performed under certain circumstances, but carotid artery stenting has proven to be a much safer, less invasive means of widening the artery and preventing stroke.

A diagram of the human head and neck, including the carotid artery.
A diagram of the human head and neck, including the carotid artery.

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When diagnostic imaging tests reveal narrowing of the carotid artery, the patient is usually hospitalized and prepared for surgery. The procedure is not painful, and patients are allowed to stay awake for the duration of the surgery. A local anesthetic is injected into the neck and sensors are hooked up to monitor vital signs. With the aid of imaging technology, a surgeon pierces the skin and guides a tiny wire to the site of the blockage. A narrow catheter containing a deflated balloon is inserted over the wire and put into place inside the artery.

As the balloon is inflated, it compresses plaque to the sides of the interior walls, thereby widening the artery. The balloon is then deflated and a mesh stent is slid into the newly opened artery. The stent prevents collapse and reduces the risk of further cholesterol buildup in the blood vessel. Following carotid artery stenting, the surgeon uses real-time x-rays to confirm the procedure was successful. The patient is then brought to a recovery room for continuous monitoring.

After two or three days, patients who are stable are allowed to go home. They are generally instructed to rest for several days and take blood pressure-regulating medication. While carotid artery stenting is generally very successful, it is still possible for cholesterol to build up in the heart or another major blood vessel. Patients need to attend regular checkups, maintain healthy diet and exercise regimens, and avoid smoking to minimize the risk of future health problems.

The carotid artery, which is located in the neck, supplies the brain with oxygenated blood.
The carotid artery, which is located in the neck, supplies the brain with oxygenated blood.

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