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By Mayo Clinic staff
Carotid angioplasty is considered a nonsurgical procedure, because it's less invasive than 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 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 sheath (small tube) 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 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 the day 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) 24 hours after the procedure.
- Lanzino G, et al. Treatment of carotid artery stenosis: Medical therapy, surgery or stenting? Mayo Clinic Proceedings. 2009;84:362.
- Greelish JP, et al. Carotid angioplasty and stenting. http://www.uptodate.com/home/index.html. Accessed April 9, 2009.
- Riles TS, et al. Cerebrovascular disease. In: Townsend CM Jr, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa.: Elsevier Saunders; 2007. http://www.mdconsult.com/das/book/body/130704983-4/0/1565/619.html?tocnode=54739952&fromURL=619.html#4-u1.0-B978-1-4160-3675-3..50068-X_3758. Accessed April 9, 2009.
- Sacco RL, et al. Primary prevention of ischemic stroke. Stroke. 2006;37:577.
- Angioplasty and vascular stenting. Radiological Society of North America. http://www.radiologyinfo.org/en/info.cfm?pg=angioplasty. Accessed April 10, 2009.
- Carotid artery disease. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/catd/catd_all.html. Accessed April 14, 2009.
