Carotid Angioplasty and Stenting
In carotid angioplasty, a surgeon uses a microcatheter -- a long tube tipped with miniature instruments -- to reopen a blockage of the carotid artery in the neck. Such blockages can cause a devastating stroke or increase the risk of stroke, because the carotid supplies the brain with much of its blood supply.
In the angioplasty procedure, the specialist threads the catheter through an artery in the groin to the site of the blockage, where a miniature balloon reopens the carotid artery. The doctor also may insert a stent — a kind of meshwork collar — to help hold the artery open. Angioplasty also can be performed on blockages in the vertebral artery which threaten blood supply to the spinal cord.
Angioplasty vs. Surgery: Choosing the Best Option
The surgical alternative to angioplasty, called endarterectomy, may be preferable for some patients with severe blockages but without increased risk factors such as significant coronary artery disease. Research has demonstrated the superiority of endarterectomy over nonsurgical therapy (medical management) in reversing serious, symptom-causing narrowing of the carotid artery. Other studies showed a statistically significant reduction in stroke incidence after carotid endarterectomy compared with medical management in patients with serious but asymptomatic carotid stenosis (a partial blockage of the carotid artery that doesn’t cause symptoms).
In patients who also have significant coronary artery disease, carotid angioplasty and stenting can be performed effectively, with lower complication rates and less chance of re-narrowing and a consequent need for further intervention.
While studies of endarterectomy and angioplasty continue, angioplasty offers an attractive option for people with a high risk for surgical complications. MINC surgeons perform more than 100 angioplasties and stentings per year, crafting treatment plans to each patient’s individual condition, using the full range of options to give the best chance of success. This intensive, multi-specialty approach may include:
- medical therapy for the atherosclerosis (hardening of the arteries) that underlies carotid blockages
- selection of patients most likely to benefit from angioplasty
- selection of the best method (balloon only or balloon plus stent) for the individual patient
- endarterectomy, when it is a better option
- individualized postprocedure care
- treatment of underlying heart disease by specialists at the UPMC Cardiovascular Institute
To learn more about carotid angioplasty and stenting at MINC, or to request a consultation, go to appointments & referrals.