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Carotid artery stenosis and plaque: when stenting is needed
The carotid arteries supply the brain. An atherosclerotic plaque in the internal carotid artery can become a source of embolism or critically narrow the lumen, and this is how ischemic stroke develops. Carotid stenosis (narrowing of the carotid artery) that is detected in time is treated before a stroke, not after one.
Symptoms of carotid stenosis and when to get checked
- Past episodes of sudden short-lived weakness or numbness of an arm, a leg or one side of the face (if such symptoms occurred just now or within the last few days, see the next section)
- Past episodes of transient loss of vision in one eye or speech disturbance
- A previous ischemic stroke or transient ischemic attack
- A stenosis of more than 50% found on duplex ultrasound
- Atherosclerosis elsewhere, diabetes or smoking — indications for carotid screening
Stroke or TIA (“mini-stroke”): 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 — even if the symptoms disappear within minutes. Do not wait for a scheduled consultation and do not message the doctor first.
An episode that resolves on its own is a transient ischemic attack (TIA). It is an emergency: the risk of stroke is highest in the first hours and days afterwards, and treatment that reopens the blocked brain artery (thrombolysis, thrombectomy) is possible only within the first hours after symptom onset. After a TIA or minor stroke (a stroke without lasting severe deficit) the carotid arteries are examined urgently. Intervention for a symptomatic stenosis — one that has already caused a TIA or stroke — is most beneficial early: according to clinical guidelines, within about 14 days of the episode.
Indications for intervention
Symptomatic stenosis above 50% and severe asymptomatic stenosis (usually above 70%), taking age and comorbid risks into account. Lesser degrees of stenosis are treated medically: statins, antiplatelet agents, blood pressure control.
Diagnosis
Duplex ultrasound of the carotid arteries, CT angiography; a neurologist's consultation when indicated.
Endovascular treatment
Carotid stenting through a puncture of the femoral or radial artery with a cerebral protection system that shields the brain from plaque fragments. No incision in the neck, local anesthesia; hospital stay of 1–2 days. The alternative is carotid endarterectomy (open surgery), which is also performed at the Center; the method is chosen according to the patient's anatomy and individual risks.
Frequently asked questions
Weakness in my arm or trouble speaking went away within minutes. Can I wait for a scheduled appointment?
No. This may have been a transient ischemic attack, which is an emergency even after full recovery: the risk of stroke is highest in the first hours and days afterwards. Call an ambulance (103 in Ukraine) even if the symptoms have gone; the work-up, including the carotid arteries, is done urgently. If such an episode happened in the past few days and you have not been assessed yet, seek medical care today rather than waiting for a scheduled appointment.
Is carotid stenting painful?
No — local anesthesia at the puncture site. The patient is awake, which allows neurological status to be monitored during the procedure.
Stenting or endarterectomy?
Both are effective for stroke prevention. Stenting is preferred with high surgical risk, after neck radiotherapy or for restenosis; endarterectomy in other situations. The decision is individual.
How long do I take medication after stenting?
Dual antiplatelet therapy for several weeks or months, then one antiplatelet agent and a statin permanently.
Can stenosis be treated without a procedure?
Moderate stenosis — yes, medically, with yearly duplex ultrasound follow-up.
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.
+380 44 454 20 79