Carotid Artery Angioplasty and Stenting (CAS)

Blocked carotid arteries can lead to serious, life-threatening health problems like stroke. Carotid artery angioplasty and stenting is a minimally invasive procedure to open blocked carotid arteries and lower your risk of stroke.

UPMC vascular surgeons are experts in carotid angioplasty and stenting. Our surgeons take a team approach to quickly diagnosing and treating patients based on their individual needs.

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What Is Carotid Artery Angioplasty and Stenting?

Your carotid arteries are the vessels on either side of your neck that supply oxygen-rich blood to your brain, neck, and face.

Carotid angioplasty and stenting is a procedure that uses a balloon-tipped catheter to open the blocked carotid artery. Then, a metal mesh tube called a stent is used to keep the artery open and allow for normal blood flow.

Conditions we treat with carotid artery angioplasty and stenting

Carotid artery angioplasty and stenting can treat carotid artery stenosis — the narrowing of the carotid arteries due to plaque build-up.

In most cases, blockages are caused by plaque, which is made up of fat, cholesterol, and other substances.

Why Would I Need Carotid Artery Angioplasty and Stenting?

If left untreated, carotid artery stenosis can lead to serious, even life-threatening conditions like:

• Stroke.
• Transient ischemic attack (also called a TIA or mini stroke).

In some cases, a stroke or mini stroke is the first sign of a blocked carotid artery. These conditions are medical emergencies that can lead to permanent disability and death without immediate treatment. 

If you think you or someone else is having a stroke or mini stroke, call 911 right away.

How serious is a stent in a carotid artery?

Carotid artery angioplasty and stenting is a complex, minimally invasive procedure that can prevent life-threatening complications. If your doctor has recommended carotid artery angioplasty and stenting, the benefits of the procedure outweigh the risks.

Who’s a candidate for carotid artery angioplasty and stenting?

If you’ve been diagnosed with carotid artery stenosis or told that you have a blocked carotid artery, you may be a candidate for carotid artery angioplasty and stenting.

Alternatives to carotid artery angioplasty and stenting

• Carotid endarterectomy.
• Transcarotid artery revascularization (TCAR).

What Are the Risks and Complications of Carotid Artery Angioplasty and Stenting?

Like any medical procedure, carotid artery angioplasty and stenting can have risks, including:

• Bleeding.
• Blood clots.
• Heart attack.
• Kidney failure.
• Restenosis (when the carotid artery with the stent becomes blocked again).
• Stroke or mini stroke (TIA).

What Should I Expect from Carotid Artery Angioplasty and Stenting?

During your first visit, your doctor will go over your medical history and perform a physical exam.

You may also have a series of tests, including:

• Angiography — This test uses a catheter inserted into the wrist or groin to inject a dye and special x-ray to find carotid artery blockages.
• CT angiogram — This test uses dye injected through an IV and a special x-ray to look at your carotid arteries.
• Ultrasound — A test that produces images using sound waves and determines the extent of the narrowed artery and the blood flow to the brain.

Before: How to prepare for carotid artery angioplasty and stenting

Your doctor will explain the carotid artery angioplasty and stenting procedure to you and give you a chance to ask questions. To prepare for the procedure, you should:

• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have heart valve disease, as you may need to receive an antibiotic before the procedure. 
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
• Fast for a certain time before the procedure. Your doctor will tell you how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.

In the days before your treatment, you will need to take aspirin and a blood-thinning medication. These prevent blood clots from building up inside the stent and help to prevent pre-operative stroke. You will continue to take these medications after your stent is placed and following discharge from the hospital.

On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

You will need to stay in the hospital for 1-2 days after your procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home from the hospital after you are discharged.

How long does carotid artery angioplasty and stenting take?

Carotid artery angioplasty and stenting typically takes up to two hours.

During your carotid artery angioplasty and stenting procedure

You will get medicine to help you relax and medicine to numb your incision site.

During your procedure, your surgeon will:

• Make a small incision or a puncture in your groin or wrist and insert a thin, flexible tube called a catheter. The catheter's tip will have a balloon.
• Use special x-ray imaging called fluoroscopy to guide the catheter to the blockage in your carotid artery.
• Inflate the balloon, pushing the plaque out of the way and restoring blood flow.
• Place a small tube made of metal mesh called a stent to hold your artery open. A stent acts as a brace against your artery wall.

During carotid artery angioplasty and stenting, there is a risk that clots (emboli) from the blockage could dislodge, travel to your brain, and cause a stroke. To reduce your stroke risk, your doctor will use an embolic protection device (EPD) to "catch" any clots or small debris that might break loose.

Recovery after carotid artery angioplasty and stenting

After the catheter is removed, your medical team will apply pressure to the insertion site for several minutes to help stop the bleeding. If the catheter was inserted through your groin, you must remain lying down for 4-6 hours and refrain from moving the limb where the catheter was inserted. If the catheter was inserted in your wrist, you may be able to move around sooner.

Your medical team will need to monitor your condition and check the insertion site frequently, so you will need to remain in the hospital overnight. It is very important that you follow your discharge instructions and take good care of your insertion site to prevent complications.

How long does it take to recover after carotid artery angioplasty and stenting?

Talk to your doctor about when you can resume normal activities or return to work. It also is very important that you see your doctor for follow-up visits as recommended.

Your surgeon will suggest lifestyle changes, like:

• Eating a healthy diet.
• Getting regular exercise.
• Quitting smoking.

You will also need medicine to help:

• Control your cholesterol and blood pressure if needed.
• Prevent blood clots, most often aspirin and a blood-thinning medication.

When to call your doctor about carotid artery angioplasty and stenting complications

You should call your doctor if you are experiencing any unusual symptoms, including:

• A fever of more than 100.0°F.
• Numbness on one side of your body.
• Pain, redness, bleeding, drainage, or increased swelling at the insertion site.
• Severe pain, coldness, numbness, or discoloration in the limb where the catheter was inserted.
• Trouble walking or speaking.

If any of these symptoms are severe, you should dial 911 immediately.

What’s the prognosis after carotid artery angioplasty and stenting?

For most patients, carotid artery angioplasty and stenting restores blood flow to the brain and helps to reduce stroke risk.

What is the life expectancy after a carotid stent?

With lifestyle changes, medication, and follow-up care, most patients can manage their stroke risk and live active, fulfilling lives. If you have questions about your life expectancy after your carotid stent, talk to your doctor.

What’s the success rate of carotid artery angioplasty and stenting?

Carotid artery angioplasty and stenting has a success rate of more than 90 percent.

Why Choose UPMC for Carotid Artery Angioplasty and Stenting?

When you choose UPMC for carotid artery angioplasty and stenting, you will receive expert care from some of the region's most experienced cardiologists. Our physicians will use the latest devices and techniques to open your blocked carotid artery and lower your risk of stroke.

If carotid angioplasty and stenting isn’t the best option for you, we offer a full range of treatment options to restore blood flow and reduce stroke risk.

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Medically reviewed by: Abigayle Dranko, PA-C on 2024/10/01.