You have an artery on each side of your neck called the carotid artery. This artery brings needed blood to your brain and face.
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. A stroke can occur if your brain does not get enough blood.
There are two invasive ways to treat a carotid artery that is narrowed or blocked. One is surgery called endarterectomy. The other is a procedure called carotid angioplasty with stent placement.
Carotid angioplasty and stenting (CAS) is done through a much smaller incision, by pushing instruments into your arteries:
Narrowing or blockage of your carotid arteries increases the risk that you may have a stroke. Carotid angioplasty and stenting is one of several treatments for this blockage.
There are several ways your doctor may know you have narrowing or blockage in your carotid artery. Two common ones are:
Your doctor will need to do one or more tests to see how blocked one or both of your carotid arteries are.
Other options that your doctor will discuss with you are:
Tests will be done to check your carotid artery. Surgery or angioplasty to remove the buildup in your carotid artery may be done if the carotid artery is severely narrowed, or if the narrowing is moderate, but your doctor thinks you are at high risk of having a stroke.
Carotid surgery (endarterectomy) is a safe surgery and is often the first invasive choice to treat carotid artery narrowing.
If you have had a stroke, your doctor will consider whether treating your blocked artery with surgery is safe for you. Your doctor will compare your risk of having another stroke if you do not have surgery with the risk of having serious problems from the surgery itself.
Carotid angioplasty and stenting is more likely to be used when carotid endarterectomy would not be safe.
Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.
Angioplasty with or without stenting may be used to treat:
Not every blockage in the coronary arteries can be treated with angioplasty. Some patients who have many blockages or blockages in certain locations may need a coronary bypass (heart surgery).
The risks for any anesthesia are:
The risks for any surgery are:
Risks of carotid surgery are:
Your doctor will do a thorough physical exam and several medical tests.
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
Do NOT drink anything after midnight the night before your surgery, including water.
On the day of your surgery:
You may have a drain in your neck that goes into your surgical cut. It will drain fluid that builds up in the area. It will be removed within a day.
After surgery, your doctor may want you to stay in the hospital overnight so that nurses can watch you 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.
Carotid artery surgery 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 doctor tells you exercise is safe for you.
Carotid angioplasty and stenting; CAS; Angioplasty - carotid artery
International Carotid Stenting Study Investigators. Dobson EJ, Featherstone RL, Bonati LH, van der Worp HB, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010;375:985-997.
Goldstein LB. Prevention and management of stroke. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: W.B. Saunders; 2007:chap 58.
Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660-1671.
Eckstein HH, Ringleb P, Allenberg JR, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008;7:893-902.
Adams RJ, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, et al. Update to the AHA/ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2008;39:1647-1652.
Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington.
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