An alternative to carotid endarterectomy is to treat the narrowing in the carotid artery with a stent. The plaque in the artery wall is not removed but the narrowing is dilated with a balloon and stent. This improves flow through the artery and reduces the risk of clots building up and causing strokes in the future. The evidence shows that this procedure is successful at reducing the risk of stroke from symptomatic patient's with a significant carotid stenosis. There is some concern about the risk of stroke at the time of stent insertion. This procedure requires the and a team with experience in carotid stenting in order to gain good results with maximum benefit for the patient. When these resources are not available the results of stenting can show a higher stroke rate than for carotid endarterectomy.
In centres with good experience carotid stenting does provide a useful alternative for treating carotid disease. An operation on the artery may be more risky for patients with heart and breathing problems. Previous surgery to the neck can also make surgery more difficult. There are therefore situations where carotid stenting is particularly valuable.
This procedure can be performed under local anaesthetic, similar to an angiogram and angioplasty in other areas performed via the femoral artery in the groin. Most patients are monitored overnight and discharged the next day.
The angiograms below show a stenosis before (left) and after (right) stenting.
For more information on carotid stenting visit the section at the Circulation Foundation