Carotid angioplasty (kuh-ROT-id AN-je-oh-plas-te) is a procedure that opens clogged arteries to prevent or treat stroke. The carotid arteries are located on each side of your neck and are the main arteries supplying blood to your brain. The procedure involves temporarily inserting and inflating a tiny balloon where your carotid artery is clogged to widen the artery.

Carotid angioplasty is often combined with the placement of a small metal coil called a stent in the clogged artery. The stent helps prop the artery open and decreases the chance of it narrowing again. Carotid angioplasty and stenting may be used when traditional carotid surgery isn't feasible or is too risky.

Carotid angioplasty and stenting may be an appropriate stroke treatment or stroke prevention option if:

  • You have a history of heart problems, such as congestive heart failure, unstable angina or a failed stress test
  • You have a carotid artery with a 70 percent blockage or more, especially if you've had a stroke or stroke symptoms, and you aren't in good enough health to undergo surgery — for example, if you have severe heart or lung disease or had radiation for neck tumors
  • You've already had a carotid endarterectomy and are experiencing new narrowing after surgery (restenosis)
  • The location of the narrowing (stenosis) is difficult to access with endarterectomy

In some cases, traditional carotid surgery (carotid endarterectomy) may be advised to remove the buildup of plaques (fatty material) that is narrowing the artery. In other cases, angioplasty and stenting may be a better option.

Carotid angioplasty and stenting may be an appropriate stroke treatment or stroke prevention option if:

  • You have a history of heart problems, such as congestive heart failure, unstable angina or a failed stress test
  • You have a carotid artery with a 70 percent blockage or more, especially if you've had a stroke or stroke symptoms, and you aren't in good enough health to undergo surgery — for example, if you have severe heart or lung disease or had radiation for neck tumors
  • You've already had a carotid endarterectomy and are experiencing new narrowing after surgery (restenosis)
  • The location of the narrowing (stenosis) is difficult to access with endarterectomy

In some cases, traditional carotid surgery (carotid endarterectomy) may be advised to remove the buildup of plaques (fatty material) that is narrowing the artery. In other cases, angioplasty and stenting may be a better option.

Before a scheduled angioplasty, your doctor reviews your medical history and performs a physical exam. You may also have one or more of the following examinations before an angioplasty and stenting procedure:

  • Ultrasound. A scanner is passed over the carotid artery to produce images (using sound waves) of the narrowed artery and of the blood flow to the brain.
  • Magnetic resonance angiography (MRA) or computerized tomography angiography (CTA). These exams provide highly detailed images of blood vessels by using either radiofrequency waves in a magnetic field or by using X-rays.
  • Carotid angiography. During this exam, contrast material (visible on X-rays) is injected into an artery so that vessels can be seen and examined.

You'll receive instructions on what you can or can't eat or drink before angioplasty. Your preparation may be different if you're already staying at the hospital before your procedure.

The night before your procedure:

  • Follow your doctor's instructions about adjusting your current medications. Your doctor may instruct you to stop taking certain medications before angioplasty, particularly if you take certain diabetes medications or blood thinners.
  • Take approved medications with only small sips of water.
  • Arrange for transportation home. Angioplasty usually requires an overnight hospital stay, and you won't be able to drive yourself home the next day because of lingering effects of the sedative.

Carotid angioplasty is considered a nonsurgical procedure because it's less invasive than is surgery. Your body isn't cut open except for a very small cut in a blood vessel in your groin.

General anesthesia isn't needed, so you're awake during the procedure. You'll receive fluids and medications to relax you through an intravenous (IV) catheter.

Before the procedure

  • You're taken to an X-ray imaging room and asked to lie on a procedure bed. You'll rest your head in a cup-shaped area to help you remain comfortable and still while pictures of the carotid artery are taken.
  • Your groin is shaved and prepared with antiseptic solution, and a sterile drape is placed over your body.
  • A local anesthetic is injected into your groin to numb the area.
  • Small electrode pads are placed on your chest to monitor your heart rate and rhythm during the procedure.

During the procedure

Once you're sedated, your doctor makes a puncture in an artery, usually the femoral artery in the groin area. The following steps describe the angioplasty and stenting procedure.

  • A small tube (sheath) is placed into the artery. A catheter is then threaded through the tube to the narrowing in the carotid artery under X-ray guidance. You won't feel the catheter passing through the arteries because the insides of arteries don't have nerve endings.
  • Contrast material is injected into the carotid artery through the catheter. The contrast material may cause a temporary warm feeling on one side of your face. Contrast material provides a detailed view of the narrowed artery and blood flow to the brain.
  • An umbrella-shaped filter is placed. The filter (embolic protection device) is inserted beyond the narrowing to catch any debris that may break off from the narrowed area of artery during the procedure.
  • The balloon is inserted into the narrowed area and inflated to push the plaques to the side and widen the vessel.
  • A small metal mesh tube (stent) may be placed in the newly opened vessel. The expanded stent serves as a scaffold that helps prevent the artery from narrowing again.
  • The filter, sheath and catheter are removed. Pressure is applied to the small catheter insertion site to prevent bleeding.

When the procedure is done, you lie still in one position while pressure is applied to the site to stop bleeding. You will then be taken to the recovery area.

After the procedure

To avoid bleeding from the catheter insertion site, you need to lie relatively still for several hours, either in the recovery area or in your hospital room. After the procedure, you may receive an ultrasound of your carotid artery. Most people are discharged from the hospital within 48 hours after the procedure.

The catheter site may remain tender, swollen and bruised for a few days. There may be a small area of discoloration or a small lump in the area of the puncture. You may take acetaminophen (Tylenol, others) in the recommended dose as needed for discomfort, or other medication as prescribed by your doctor.

You may need to avoid strenuous activity and lifting anything over 10 pounds (4.5 kilograms) for 24 hours after the procedure.

For most people, carotid angioplasty and stenting increase blood flow through the previously blocked artery and reduce the risk or symptoms of stroke.

Seek emergency medical care if your symptoms return, such as trouble walking or speaking, numbness on one side of your body, or other symptoms similar to those you had before your procedure, contact your doctor immediately.

Carotid angioplasty and stenting aren't appropriate treatment for everyone. Your doctor can determine if the benefits outweigh the potential risks. Because carotid angioplasty is newer than traditional carotid surgery, long-term results are still under investigation. Talk to your doctor about what results you might expect and what type of follow-up is needed after your procedure.

Lifestyle changes will help you maintain your good results:

  • Don't smoke.
  • Lower your cholesterol levels.
  • Maintain a healthy weight.
  • Control other conditions, such as diabetes, high blood pressure and sleep apnea.
  • Exercise regularly.

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Doctors from vascular surgery and interventional neuroradiology perform carotid angioplasty and stenting. They work with doctors in neurology to determine if carotid angioplasty and stenting is an appropriate treatment.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

Doctors from vascular surgery and interventional neuroradiology perform carotid angioplasty and stenting. They work with doctors in neurology to determine if carotid angioplasty and stenting is an appropriate treatment.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

Doctors from vascular surgery and interventional neuroradiology perform carotid angioplasty and stenting. They work with doctors in neurology to determine if carotid angioplasty and stenting is an appropriate treatment.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

Please refer to the international appointment section to request appointments via phone.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Because carotid angioplasty and stenting is a new, less invasive procedure, researchers are still studying its long-term ability to treat carotid artery disease. Mayo Clinic investigators conduct studies that compare carotid endarterectomy and carotid angioplasty and stenting outcomes.

Jul. 23, 2011