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The blood vessels that bring blood to your brain and face are called the carotid arteries. You have a carotid artery on each side of your neck.
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. Sometimes part of a plaque can break off and block off another artery. A stroke can occur if your brain does not get enough blood.
Two procedures can be used to treat a carotid artery that is narrowed or blocked. These are:
Carotid angioplasty and stenting; CAS; Angioplasty - carotid artery; Carotid artery stenosis - angioplasty;
Carotid angioplasty and stenting (CAS) is done using a small surgical cut.
Carotid surgery (endarterectomy) is an older and effective way to treat narrowed or blocked arteries. This procedure is very safe.
Carotid angioplasty and stenting has developed as a good alternative to surgery, when done by experienced operators. Certain factors may favor stenting, such as:
Risks of carotid angioplasty and stent placement, which depend on factors such as age, are:
Your health care provider will do a physical exam and perform several medical tests.
Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your procedure:
DO NOT drink anything after midnight the night before your surgery, including water.
On the day of your surgery:
After surgery, you may need to stay in the hospital overnight so that you can be watched for any signs of bleeding, stroke, or poor blood flow to your brain. You may be able to go home the same day if your procedure is done early in the day and you are doing well. Your health care provider will talk to you about how to care for yourself at home.
Carotid artery angioplasty and stenting may help lower your chance of having a stroke. But you will need to make lifestyle changes to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. You may need to change your diet and start an exercise program if your provider tells you exercise is safe for you.
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Brott TG, Halperin JL, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. J Am Coll Cardiol. 2011. PMID: 23281092 www.ncbi.nlm.nih.gov/pubmed/23281092.
Brott TG, Hobson RW, Howard G, et al: Stenting versus endarterectomy for treatment of carotid-arery stenosis. N Engl J Med. 2010;363(1):11-23. PMID: 20505173 www.ncbi.nlm.nih.gov/pubmed/20505173.
Gurm HS, Yadav JS, Fayad P, et al: Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008;358(15):1572-9. PMID: 18403765 www.ncbi.nlm.nih.gov/pubmed/18403765.
Kinlay S, Bhatt DL. Treatment of noncoronary obstructive vascular disease. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 60.
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.