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Carotid artery stenting: who needs it, how it is done and what to expect afterward
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Carotid artery stenting is an endovascular procedure in which a stent is placed where plaque narrows the internal carotid artery. A stent is a mesh metal scaffold that widens the artery and presses the plaque against its wall. The aim is to reduce the risk of stroke. The procedure is performed through a puncture of an artery in the groin or at the wrist, without an incision in the neck, under local anesthesia.
Who needs carotid artery stenting
A procedure — stenting or open surgery — is considered above all for symptomatic stenosis of more than 50%, that is, a narrowing that has caused a transient ischemic attack (TIA) or stroke within the past 6 months. A procedure is most beneficial early: according to clinical guidelines, within about 14 days of the episode. In the first 14 days after symptoms, and in patients aged 70 or older, the guidelines recommend endarterectomy rather than stenting, because in these situations the risk of stroke during stenting is higher. For severe stenosis without symptoms, whether a procedure is worthwhile is decided individually, taking into account age, general health and signs of a higher stroke risk.
A narrowing of less than 50% is treated with medicines. As a rule, a completely blocked (occluded) carotid artery is not stented. A procedure is recommended only when the expected reduction in future stroke risk outweighs the risk of the procedure itself. The degrees of narrowing are explained in more detail on the page “Carotid artery stenosis”.
Stenting or endarterectomy
The alternative to stenting is carotid endarterectomy: open surgery through an incision in the neck, during which the plaque is removed. Both methods are effective for stroke prevention, and both are performed at the Center (endarterectomy by the vascular surgery department). Stenting is considered above all when open surgery carries a higher risk because of other diseases or the anatomy of the neck; after neck radiotherapy and for renarrowing (restenosis) after surgery, the method is chosen individually. In patients younger than 70, stenting can be an alternative to endarterectomy, while in the first 14 days after symptoms and in patients aged 70 or older endarterectomy is preferred. The method is chosen according to the patient's anatomy and individual risks.
Tests before the procedure
- Duplex ultrasound of the carotid arteries
- CT angiography (computed tomography with contrast) of the blood vessels of the neck and head: it defines the degree of narrowing more precisely and shows the route along which the instruments can be passed
- A neurologist's consultation when indicated
- Blood tests, including kidney function (creatinine), and an ECG
- Tell the doctor about an allergy to iodinated contrast or chronic kidney disease
- Do not stop any medicines on your own: the doctor will tell you what to change before the procedure and when
How stenting is performed
The procedure is performed in an angiography suite under local anesthesia at the puncture site. The puncture is made in the femoral artery in the groin or in the radial artery at the wrist. Through it, under X-ray guidance, a catheter and a guidewire are advanced to the carotid artery, and a stent is then passed over the guidewire and expanded at the narrowing; if needed, the artery is widened further with a balloon.
You stay awake throughout: the doctor asks you to talk and to squeeze a hand in order to monitor how your brain is working during the procedure. When the narrowed segment is widened, the pulse sometimes slows or blood pressure drops for a short time — the doctor monitors this and corrects it if needed.
After carotid artery stenting
In the first hours after the procedure, blood pressure, pulse and neurological status are monitored. The hospital stay is usually 1–2 days. For a few days, avoid heavy lifting; if the puncture was made at the wrist, do not strain that hand during these days.
After stenting you will be prescribed medicines that prevent blood clots, and statins; the doctor decides which ones to take and for how long. Do not stop them on your own. Controlling blood pressure and blood sugar and stopping smoking are just as important. The stent is checked with follow-up duplex ultrasound at times your doctor will specify.
Possible risks
- A stroke during the procedure or shortly afterward — the main risk; that is why the procedure is recommended only when the expected benefit outweighs the risk
- A bruise, hematoma or bleeding at the puncture site
- A slowed pulse or a drop in blood pressure — usually temporary
- Hyperperfusion syndrome — excessive blood flow to the brain after the artery is widened (severe headache, seizures) — uncommon; blood pressure is controlled after the procedure to prevent it
- An allergic reaction to contrast or worsening kidney function after contrast
- Renarrowing inside the stent over time — uncommon; it is detected on follow-up ultrasound scans
When to call an ambulance
Suspected stroke: call an ambulance (103 in Ukraine). Sudden weakness or numbness of the face, an arm or a leg on one side, facial droop, speech disturbance or sudden loss of vision in one eye are an emergency — both before and after stenting, even if the symptoms disappear within minutes. Do not wait for a scheduled consultation and do not message the doctor first.
Severe headache, seizures or confusion in the first weeks after stenting: call an ambulance (103 in Ukraine). This may be hyperperfusion syndrome — excessive blood flow to the brain after the narrowing has been opened up, which is treated in hospital. Tell the dispatcher that you have recently had carotid artery stenting.
Bleeding from the puncture site or a swelling that grows quickly: press on the puncture site and call an ambulance (103 in Ukraine). Lie down and keep pressing firmly on the puncture site until the ambulance arrives.
Redness, swelling, pus or increasing pain at the puncture site, or a fever after discharge need a doctor's examination: seek medical care the same day.
Frequently asked questions
Is general anesthesia needed for carotid stenting?
No: local anesthesia at the puncture site is enough; the patient is awake, which allows neurological status to be monitored during the procedure.
How long will I stay in the hospital after carotid stenting?
Usually 1–2 days.
Carotid artery stenting or endarterectomy (surgery): which to choose?
Both are effective for stroke prevention. Stenting is considered above all when open surgery carries a higher risk; after neck radiotherapy and for renarrowing after surgery, the method is chosen individually. In the first 14 days after a transient ischemic attack (TIA) or stroke, and in patients aged 70 or older, the guidelines recommend endarterectomy. The decision is individual.
Is a completely blocked carotid artery treated with a stent?
As a rule, no: a completely blocked (occluded) carotid artery is usually not treated with a procedure; treatment is with medicines.
Can the narrowing come back after stenting?
It happens, but not often, which is why follow-up duplex ultrasound is scheduled after the procedure. If a narrowing is found, further treatment is chosen individually.
What should I do if weakness in my arm or trouble speaking appears after stenting?
Call an ambulance (103 in Ukraine) without delay, even if the symptoms have gone. Tell the dispatcher that you have recently had carotid artery stenting.
Book a consultation
Vascular surgeon consultation at the Shalimov Center, 30 Akademika Shalimova St, Kyiv. Booking and questions go through the contact doctor, Yurii Vahis. Patients from other cities and abroad can arrange an online consultation.