Carotid Artery Stent

Overview

The carotid arteries supply blood to the brain. There are two carotid arteries and two vertebral arteries that together supply the whole of the brain with blood.

Narrowing of the internal carotid artery (ICA) is associated with a risk of stroke in well people. Several studies have suggested that treating these narrowings reduces the risk of stroke compared to tablets alone.

Do I need a Carotid Artery Stent?

After a stroke or a mini-stroke, if a narrowing in the carotid artery is found (as in 5% of cases), then treatment is urgently needed and the benefits of removing the narrowing are much larger that in those who have not had a stroke. Careful consideration needs to be made on the choice of treatment and this will often involve neck scans, brain imaging and review with a multi-skilled team including neurologists, radiologist and vascular surgeons as well as the cardiologist.

Carotid narrowing treated with a stent or surgery.

 What is involved and what are the risks?

There are two treatments available to treat the narrowing: Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS). For the majority, the choice between CAS and CEA will be made by the patient and doctor together. Carotid artery stenting involves a similar procedure to Coronary Angioplasty (PCI), with the insertion of a plastic pipe from the groin up to the neck.

The danger from CAS is that the brain is unprotected from debris going upwards. Therefore, CAS is now usually done with a protection device (filter) in place. The risk of bleeding from the leg is about 1%. The risk of stroke is 1-2%. Death is very rare. This has to be balanced with the risk of  just continuing with medical therapy – extremely high if a recent stroke has occurred before the internal carotid artery narrowing was found.

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