What is carotid artery stenting?

Carotid artery stenting is a procedure in which your vascular surgeon inserts a slender, metal-mesh tube, called a stent, which expands inside your carotid artery to increase blood flow in areas blocked by plaque.

Hardening of the arteries, also known as atherosclerosis, can cause a build-up of plaque. In hardening of the arteries, plaque builds up in the walls of your arteries as you age. Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque accumulates, your arteries can narrow and stiffen. Eventually, enough plaque may build up to reduce blood flow through your arteries, or cause blood clots or pieces of plaque to break free and to block the arteries in the brain beyond the plaque.

Your carotid arteries are located on each side of your neck and extend from your aorta in your chest to the base of your skull. These arteries supply blood to your brain. You have one main carotid artery on each side, and each of these divides into two major branches, the external and the internal carotid arteries. The external carotid supplies blood to your face and scalp. Your internal carotid artery is more important because it supplies blood to the brain.

When plaque builds up and reduces blood flow in your carotid arteries, you have carotid artery disease. This is a serious issue because clots can form on the plaque and block the blood flow to your brain. If a clot or plaque blocks the blood flow to your brain, it can cause an ischemic stroke, which can cause brain damage or death. An ischemic stroke is a stroke that occurs because there is a lack of blood flow to cells in the brain. Another related problem that the plaque can cause is an arterial embolism. This occurs when a small piece of plaque or a blood clot breaks away from the site where it formed and blocks another artery downstream. If a clot blocks a tiny artery in the brain, it may cause temporary neurological symptoms, called transient ischemic attacks (TIAs), sometimes called "mini-strokes."

When your physician wants to treat a blocked carotid artery, he or she, in some circumstances, may recommend that you have a stent inserted as an alternative to surgical removal of the plaque, known as carotid endarterectomy. During the carotid stenting procedure, your physician inserts a stent into your carotid artery after performing angioplasty. Angioplasty uses a balloon inflated in the narrowed part of the artery to flatten the plaque and open the artery. The stent holds the artery open by holding back the flattened plaque like scaffolding in a mineshaft.

 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.

Am I a candidate for carotid stenting?

At the present time, carotid stenting has been approved for the treatment of patients with symptomatic carotid artery disease who are considered to be too high risk for carotid endarterectomy. You may be a candidate for the procedure if you are considered high risk for carotid endarterectomy, if your carotid artery is significantly narrowed (usually by more than 70 percent), and if you have had symptoms of a mini-stroke or stroke. If you fall outside of these categories, you may be a candidate for enrollment in a clinical trial evaluating the outcomes of carotid artery stent placement.