Having Carotid Angioplasty and Stenting
Angioplasty and stenting is a type of procedure to improve the blood flow in an artery or vein. The carotid arteries are large arteries in your neck. During the procedure, healthcare providers use a thin tube with a balloon at its tip to open up the artery (angioplasty). A tiny mesh tube called a stent is put into the artery. It is left in place to help keep the artery open. This is a minimally invasive procedure done with a small cut (incision).
What to tell your healthcare provider
Before the procedure, make sure to tell the medical team if you:
Have had any recent changes in your health, such as a fever
Are pregnant or could be
Are allergic to shellfish or iodine
Have ever had a bad reaction to contrast dye
Have ever had a problem with medicine that helps you relax (sedation)
Tests before your procedure
You may need some tests before the procedure, such as:
Blood tests, to check for anemia and infection
An electrocardiogram (ECG), to check your heart rhythm
A chest X-ray, to look at your heart and lungs
Ultrasound of your neck, to look at the carotid artery
CT angiogram of the blood vessels of your neck and head
Getting ready for your procedure
Talk with your healthcare provider about how to get ready for your procedure. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your procedure. Talk with your healthcare provider if you need help to stop smoking.
Don't eat or drink after midnight the night before your procedure. Your healthcare provider may give you more instructions about how to get ready.
On the day of your procedure
Talk with your healthcare provider about what to expect during your procedure. The procedure will likely be done by a doctor trained in vascular medicine and a team of specialized nurses. A typical procedure may go like this:
An IV (intravenous) will be put in your arm or hand before the procedure starts. You’ll be given sedation through the IV line. This will make you relaxed and sleepy during procedure.
Hair in the area of your procedure may be removed. The area may be numbed with a local anesthesia.
The doctor will make a small incision in a blood vessel in your groin. He or she will then put a long, thin wire into this cut. The wire acts as a guide during the procedure.
The doctor will then insert a thin, flexible tube (catheter) over the wire. It has a tiny deflated balloon on the end. The catheter will be threaded through the blood vessel all the way into the carotid artery in your neck. Continuous X-ray images may be used to show exactly where the catheter is.
The doctor will inflate the balloon inside the narrow part of the carotid artery. This will stretch the area open.
A mesh tube called a stent may be left in place in the area. This will help keep the area open.
The doctor will deflate the balloon. He or she will remove the catheter.
The doctor will close and bandage the incision site in the groin.
After your procedure
After the procedure, you will spend several hours in a recovery room. You may be sleepy and confused when you wake up. Your healthcare team will watch your vital signs, such as your heart rate and breathing. You’ll be given pain medicine if you need it.
You may need to lie flat without bending your legs for several hours after the procedure. This is to help prevent bleeding from the incision site. You may be able to go home the same day. Or you may need to stay in the hospital overnight. Your doctor will tell you more about what to expect. When you’re ready to go home, you’ll need to have a family member or friend drive you.
Recovering at home
Your doctor may prescribe medicines to help prevent blood clots or spasm of your blood vessels. Follow all of your healthcare provider’s instructions. This includes any advice about medicines, exercise, and wound care. You may have some pain after the procedure. You may notice a bruise where the catheter was inserted. You can take over-the-counter pain medicines if you need to. Get some rest and don't do any strenuous exercise for at least 24 hours.
If you had symptoms from your carotid stenosis, these should go away after the procedure. In follow-up appointments, your healthcare provider will talk with you about your continued care. This includes ways to lower your risk for atherosclerosis. You also may need follow-up blood tests or imaging of your neck.
When to call your healthcare provider
Call your healthcare provider right away if you have any of these:
Fever of 100.4°F (38.0°C) or higher, or as advised by your healthcare provider
Swelling or pain at the incision site that gets worse
Fluid or blood leaking from the incision site
Redness or warmth at the incision site
Symptoms of stroke including changes in speech or vision, weakness on one side of the face or body, severe sudden headache, difficulty understanding or walking
March 15, 2018
Mohler ER, Fairman EM. Management of asymptomatic carotid atherosclerotic disease. UpToDate., Mohler ER, Fairman RM. Carotid artery stenting and its complications. UpToDate., Mohler ER, Fairman RM. Management of symptomatic carotid atherosclerotic disease. UpToDate.
Hanrahan, John, MD,Sudheendra, Deepak, MD