Carotid Angioplasty and Stenting

A newer technique for treating carotid artery disease known as Carotid Angioplasty and Stenting (CAS) has become available which involves placing a stent and then stretching the partially blocked carotid artery via a needle and catheter through the groin. A filter (called a cerebral protection device) is placed beyond the plaque before the stent is deployed in order to reduce the amount of material that showers or embolises to the brain during the procedure.

While this "keyhole" surgery is appealing and results so far are promising, its benefit over traditional endarterectomy is not conclusively proven. Current evidence suggests that it may offer a quicker recovery over carotid endarterectomy, but further work needs to be done to confirm whether it is as effective or as safe as carotid endarterectomy. A number of trials are currently in progress to determine the best role of this operation.

It is not suitable for all patients, but in some situations it is the most appropriate operation for this condition, and requires careful clinical judgement and discussion.

Carotid angioplasty and stenting (CAS) procedure. The stenosis is crossed with an embolic protection device (or filter). A stent is then introduced and the stenosis is angioplastied with a  balloon. The balloon and filter are then removed, leaving the stent behind. Images courtesy of Boston Scientific.