Carotid Angioplasty and Stenting (CAS) is a catheter-based procedure used to open narrowed or blocked carotid arteries — the major blood vessels in the neck supplying blood to the brain. By restoring blood flow and stabilizing plaque, CAS plays a vital role in stroke prevention, especially in high-risk or symptomatic patients.
Carotid angioplasty and stenting restores blood flow to the brain and helps prevent stroke in high-risk patients.
Why Carotid Arteries Are Important
The carotid arteries supply nearly 70–80% of brain blood flow. When these arteries become narrowed (carotid artery stenosis), the risk of:
- Stroke
- Transient Ischemic Attack (TIA or “mini stroke”)
- Sudden neurological deficits
What Causes Carotid Artery Stenosis?
Common risk factors:
- Atherosclerosis (fatty plaque buildup)
- Diabetes
- High blood pressure
- High cholesterol
- Smoking and tobacco use
- Heart disease
- Age > 60 years
- Family history of stroke/vascular disease
Warning Signs & Symptoms
Carotid stenosis is often silent until stroke occurs.
Symptoms may include:
- Sudden weakness or numbness (face, arm, or leg)
- Difficulty speaking or slurred speech
- Sudden vision loss
- Loss of balance or coordination
- TIA episodes (“warning strokes”)
Who Should Undergo Carotid Stenting?
According to AHA/ACC, ESC, and CREST trial evidence, CAS is recommended in:
- ✔ Symptomatic patients:
- ≥70% stenosis confirmed by imaging
- History of TIA, minor stroke, or neurological symptoms
- ✔ Asymptomatic patients:
- 80% stenosis with high-risk plaque or rapidly progressing disease
- ✔ Patients unsuitable for surgery (CEA) due to:
- Severe heart disease
- Prior neck surgery or radiation
- High surgical risk anatomy
- Bilateral carotid disease
- How the Procedure Is Performed
- ✔ Local anesthesia (patient remains awake)
- ✔ Access through femoral or radial artery
- ✔ A small filter device is placed beyond the narrowing to capture debris and prevent stroke
- ✔ A balloon gently opens the narrowing
- ✔ A self-expanding stent is placed to keep the artery open
- ✔ Filter is removed and blood circulation is restored
Benefits of Carotid Angioplasty and Stenting
- Prevents future stroke
- Minimally invasive (no open neck surgery)
- Faster recovery and less discomfort
- Suitable for elderly and high-risk patients
- Avoids surgical scar and risk of nerve injury seen in CEA
Success & Outcomes
- High success rates (>95%) in experienced hands
- Long-term stent patency is excellent
- Stroke risk significantly reduced after treatment
Potential Risks (Rare)
- Stroke during procedure (significantly reduced with embolic protection devices)
- Temporary weakness or numbness
- Restenosis (<5–10% cases)
- Groin access bleeding
- Contrast allergy (rare and preventable)
Aftercare & Follow-Up
- Resume normal activity within 24–48 hours
- Continue anti-platelet medicines (Aspirin + Clopidogrel)
- Undergo repeat carotid Doppler at 3 months, 6 months, then yearly
