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Endovascular Carotid Stenting

(Endovascular Coiling)

End-o-vaz-ku-larr Carr-de-ak Stent

Definition

An endovascular carotid stent is a mesh tube that is placed in a blood vessel in the neck. The stent will help to prop open the blood vessel and improve blood flow to the brain.

Reasons for Procedure

Plaque can build up on blood vessel walls. It can slow or block the flow of blood. The carotid artery supplies blood to the brain. Poor blood flow through the carotid can cause damage to the brain and lead to a stroke. The stent improves blood flow to the brain and lowers the risk of stroke.

Possible Complications

Problems are rare, but all procedures have some risk. Your doctor will review some problems that may happen, such as:

  • Infection
  • Allergic reactions to anesthesia or contrast dye
  • Stroke due to a blood clot
  • Bleeding
  • Kidney damage
  • Heart attack
  • The artery becomes narrow again

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of problems, such as:

What to Expect

Prior to Procedure

Your doctor may do the following:

  • Blood and urine tests
  • ECG—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Imaging tests to assess the arteries include:

Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.

The night before, eat a light meal. Do not eat or drink anything after midnight.

Anesthesia

  • General anesthesia will keep you asleep during the procedure.
  • Local anesthesia—The area will be numbed.

Description of the Procedure

You will lie flat on a table. A roll will be placed under your shoulder. Your head will be turned to the side. A cut in the skin will be made along the side of the neck. The cut will run from just behind the ear to a point above the breastbone. Clamps will be placed above and below the plaque on the carotid artery. In some cases, a temporary bypass tube will be used to maintain blood flow around the area that is being operated on.

The artery will be opened and cleaned of plaque. The artery will then be sewn back together. The clamps and bypass tube, if used, will then be removed. A section of the carotid artery may need to be removed. In this case, an artificial graft or a segment of vein will be sewn in to replace it. The neck incision will be closed with stitches.

Immediately After Procedure

An arteriogram may be done to ensure that there are no complications, such as blood clots or narrowing. You may be given medication to help prevent blood clotting.

How Long Will It Take?

2-4 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 1-3 days. Your doctor may choose to keep you longer if complications occur.

Post-procedure Care

At Home

It may take up to 2 weeks to recover. Slowly return to normal activity as tolerated. You may be referred to a dietitian who can help with dietary changes. These changes will help prevent a return of plaque build-up. Changes focus on a diet low in saturated fat. Make sure your diet is high in fruits, vegetables, grains, and fish.

Call Your Doctor If Any of the Following Occurs

Call your doctor if any of these occur:

  • Signs of infection, such as fever and chills
  • Redness, swelling, pain, bleeding, or discharge from the incision
  • Pain that you cannot control with the medicine you were given
  • Pain, swelling, cramping, or loss of feeling in your legs
  • Chest pain
  • Lightheadedness

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

American Heart Association
http://www.heart.org

National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

REFERENCES:

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: executive summary. Stroke. 2011 Aug;42(8):e420-63 full-text, correction can be found in Stroke 2011 Aug;42(8):e541.

Carotid angioplasty and stenting. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/carotid-angioplasty-and-stenting. Accessed July 19, 2019.

Carotid artery disease: carotid stenting. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/treatments/16850-carotid-artery-disease-carotid-stenting. Accessed July 19, 2019.

Carotid artery stenosis repair. EBSCO DynaMed website. Available at: https://www.dynamed.com/topics/dmp~AN~T116305/Carotid-artery-stenosis-repair. Updated May 13, 2019. Accessed July 19, 2019.

Carotid artery stenting. British Society of Interventional Radiology website. Available at: https://www.bsir.org/patients/carotid-artery-stenting. Accessed July 19, 2019.

Carotid stenting. UCSF Department of Surgery website. Available at: https://surgery.ucsf.edu/conditions--procedures/carotid-stenting.aspx. Accessed July 19, 2019.

Endovascular angioplasty with stenting (CAS). Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/cerebrovascular/treatment/carotid_angioplasty_with_stenting.html. Accessed July 19, 2019.

Last reviewed August 2019 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated: 10/15/2019