A carotid stent is a medical device that is inserted into the carotid artery to hold open a blocked carotid artery. The stent, usually made of wire mesh, is narrow and constricted while being moved through the artery. Once guided into place by a physician, it is expanded to form a hollow tube that permits blood flow to the brain. There is debate in the medical community about whether carotid plaque buildup is better managed with carotid stents or with surgical removal.
The carotid arteries are located on each side of the neck. The two carotid arteries begin at the chest aorta and extend to the bottom of the skull, where each artery branches into inner and outer carotid arteries. Over time, these arteries can become blocked with plaque and cause a stroke. Prior to U.S. Food and Drug Administration (FDA) approval of the carotid stent, the only other surgical procedure to help patients in the U.S. with blocked carotid arteries was surgical removal of the plaque.
A physician may perform angioplasty to ready the artery for the carotid stent. A small balloon is maneuvered through the arteries until it is in position in the area with the plaque buildup. The physician inflates the balloon, pushing the plaque against the artery walls and creating a wider opening in the artery. The balloon is then removed and the carotid stent is moved into place. The stent works like a permanent balloon, keeping the plaque pressed against the artery wall and allowing the free flow of blood through the artery.
The patient is usually awake for both the balloon angioplasty and the placement of the carotid stent. The physician uses live fluoroscopy imaging to guide the balloon and stent. The complete procedure usually takes between one and two hours. There is less surgical trauma to the patient with carotid stenting than with carotid endarterectomy, the surgical removal of carotid plaque. The placement of a carotid stent involves a smaller incision and less anesthesia than carotid endarterectomy.
There are risks associated with carotid stenting. Pieces of plaque may break off during the placement of the stent and cause a stroke. The stent may encourage the formation of blood clots, increasing the risk of stroke. In a 2010 study, patients with carotid stents had a higher risk of strokes or death compared with patients who underwent carotid endarterectomy. The same study, however, showed that stented patients had a lower risk of heart attacks over the long-term.
Not all patients are suitable candidates for carotid stenting. The procedure is not recommended for patients with completely blocked arteries or those who have already experienced a stroke. Patients with a life expectancy of less than two years or those with an irregular heartbeat are also not suitable candidates for carotid stenting. In these situations, the doctor may choose instead to perform a carotid endarterectomy.