Carotid Angioplasty and Stenting

Carotid angioplasty and stenting is a minimally invasive surgical procedure to treat carotid artery disease which occurs when plaque builds up in the two larger arteries on each side of your neck (the carotid arteries). The carotid arteries supply your brain with oxygen-rich blood. This condition can also be treated with carotid endarterectomy. Carotid angioplasty is usually considered for the patient who is high risk for carotid endarterectomy. Your vascular surgeon will discuss with you which option is best for you.

The narrowing of the carotid arteries is most commonly related to atherosclerosis (a buildup of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery). Atherosclerosis, or "hardening of the arteries," is a vascular disease (disease of the arteries and veins). Carotid artery disease is similar to coronary artery disease, in which blockages occur in the arteries of the heart.

Board-certified surgeons at Brigham and Women’s Hospital (BWH) have high-volume expertise in all types of vascular procedures including surgical treatment for carotid artery disease. This experience and their collaboration with a multidisciplinary team of specialists enable our surgeons to handle the most complicated cases, with a range of treatment options that improve the lives of patients throughout the world.

With 47,000 outpatient visits each year, the BWH Heart & Vascular Center is one of the largest in the United States, treating over 7,000 inpatients and performing more than 8,000 procedures annually at our state-of-the-art Shapiro Cardiovascular Center.

Carotid Angioplasty and Stenting

How a Carotid Artery Angioplasty is Performed

During this minimally invasive procedure, a very small hollow tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. A stent is a cylinder-like tube made of thin metal-mesh framework used to hold the artery open. Because there is a risk of stroke from bits of plaque breaking off during the procedure, an apparatus, called an embolic protection device, may be used. An embolic protection device is a filter (like a small basket) that is attached on a guidewire to catch any debris that may break off during the procedure.

High risk conditions under which cartoid angioplasty and stenting may be considered include:

  • Coronary artery disease or pending open heart surgery
  • Heart failure
  • Heart valve disease
  • Angina or heart attack within the last six months

Watch this video on carotid artery disease.

Why Have a Carotid Angioplasty?

Carotid angioplasty can greatly reduce the risk of stroke in people who have carotid artery disease. A stroke can occur if the plaque in a carotid artery cracks or ruptures (bursts). Blood cell fragments called platelets stick to the site of the injury and may clump together to form blood clots. Blood clots can partially or fully block a carotid artery.

A piece of plaque or a blood clot also can break away from the wall of the carotid artery. The plaque or clot can travel through the bloodstream and get stuck in one of the brain's smaller arteries. This can block blood flow in the artery and cause a stroke.

Carotid artery angioplasty with stenting is a procedure currently being used on selected patients who are at high risk for surgery. While this procedure is performed widely, the long-term effects are still being studied.

Listen to a podcast on carotid endarterectomy and angioplasty with stenting

What You Should Expect

The BWH Heart & Vascular Center is located in the Shapiro building, across the street from BWH’s main 75 Francis Street entrance. The Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic in the Shapiro Center for preoperative information and tests.

The day of surgery, your care will be provided by surgeons, anesthesiologists and nurses who specialize in carotid angioplasty. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center where staff members will provide surgery updates.

Multidisciplinary Care

In addition to our vascular surgeons, patients also benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiovascular disorders. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn more about carotid artery disease in our online health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

Learn about the Watkins Clinic in the Shapiro Center for pre-operative information and tests.

LEARN MORE ABOUT BRIGHAM AND WOMEN’S HOSPITAL


For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.

About BWH