Carotid stenting and carotid endarterectomy

  • Carotid endarterectomy

The aim of carotid stenting and endarterectomy is to prevent strokes

What is Carotid stenting and carotid endarterectomy?

Many strokes and mini-strokes are due to blockages of the carotid arteries in the neck which supply the brain with blood.  The carotid artery in the neck is a common place to develop atherosclerosis.  This condition is explained in detail HERE. Carotid arteries affected by atherosclerosis develop a rough irregular surface which can cause blood clots to form which break off and lodge in the brain causing a stroke.

 

Blockages in the carotid artery can be corrected in two ways.  One technique is to operate on the artery to remove the blockage and repair it to leave the artery smooth and wide open.  This operation is called carotid endarterectomy.  It is highly effective at reducing the risk of stroke.

 

An alternative method is carotid artery stenting.  This involves passing a small balloon across the carotid narrowing and inflating the balloon to open the artery to improve blood flow.  The artery is then held open by a stent which is a fine metal frame to prevent the artery narrowing down again after the procedure.

 

Carotid artery stenting is a relatively new way of correcting blockages of the carotid arteries with the same goal as carotid endarterectomy; to reduce risk of stroke.  The procedure is done under local anaesthetic.  A fine wire and catheter are inserted into the femoral artery in the groin and passed up into the neck under X-ray guidance.  A balloon is inserted along the wire across the blocked artery, and the balloon inflated to open up the area of narrowing.  A stent (fine metal mesh tube) is then inserted to hold the artery open after the balloon has been withdrawn.

 

 




How does it work?

Carotid stenting will reduce the risk of a stroke occuring. 

Are there any risks I should be aware of?

The problem with passing wires, catheters and balloons past a diseased artery is that it may cause debris to break off and lodge in the brain causing a stroke.  For this reason, most carotid artery stenting devices are equipped with a so-called cerebral protection device which is a filter to catch any debris before it can pass to the brain and do damage.

 

Carotid artery stenting has the advantages of avoiding any incisions, and there is no risk of damage to nerves in the neck.  There is uncertainty over whether the risk of stroke during carotid stenting is greater than carotid surgery.  Numerous trials have compared the two techniques but there is still considerable controversy over which one is better.

 

What is it used for?

What should I do next?

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