Carotid stenting is a procedure in which a surgeon treats plaque from the carotid arteries and inserts a stent to hold them open. It is a minimally invasive treatment for carotid artery stenosis.

The carotid arteries are major arteries that run up either side of the neck, providing blood to the brain. Their vital role as the brain’s blood supply means that severe narrowing of the arteries — also known as stenosis — increases a person’s risk of stroke.

Stents are hollow mesh tubes that hold open an artery to allow blood to flow through.

This article explains the purpose of carotid stenting and what the procedure involves. It also looks at recovery, benefits, risks, and more.

A person has a hand on their neck.Share on Pinterest
vitapix/Getty Images

Carotid stenting aims to re-widen narrowed carotid arteries and hold them open to improve blood flow.

Stenosis can occur when plaque hardens and narrows the arteries. Plaque is a buildup of cholesterol, fats, and other substances on the artery wall. This makes blood flow more difficult.

Treatments such as carotid stenting can reopen the arteries, allowing blood to move through more freely.

Even if a person does not have any symptoms of carotid artery stenosis, they can still be at an increased risk of stroke, so stenting may be necessary.

Doctors usually recommend carotid stenting if an individual has 50% to 69% stenosis with symptoms, or 70% to 90% stenosis with no symptoms.

Most people with carotid artery stenosis never have symptoms, according to a 2022 article.

Carotid stenting involves inserting a stent.

Before the procedure, a person will receive a local anesthetic. Their doctor will also advise on what an individual can safely do before the procedure. This can include when to stop eating or drinking, and whether they may continue taking their medications.

The doctor inserts a catheter, which is a thin tube, through an artery in the groin. Using an X-ray, they guide the tube through to the carotid artery that has stenosis.

Then, the doctor inflates a tiny balloon at the end of the catheter to widen the artery. They will then insert a stent to hold it open.

They end the procedure by deflating and withdrawing the balloon. The stent remains in place to keep the artery open and promote easier blood flow.

For around 1 hour immediately after the procedure, a person will need to lie down to prevent bleeding from the artery.

People usually need to stay in the hospital for a single night after a carotid stenting procedure. This helps the medical team ensure that blood pressure and heart rate remain stable and that no signs of stroke or bleeding develop.

After leaving the hospital, a person may need to take blood-thinning medications such as clopidogrel or aspirin to reduce the risk of the stent developing a blockage.

Carotid stenting provides a way to reduce carotid artery stenosis and its stroke risk for those with previous neck injuries or people for whom carotid endarterectomy would carry too much risk.

A 2019 study monitoring individuals for 10 years after stenting found that the stroke risk was 0.6%.

Like any procedure, there are some risks with carotid stenting. It may not be suitable for every individual with carotid stenosis.

During the procedure, plaque may break off, increasing a person’s risk of stroke. However, surgeons can minimize this by inserting a small filter basket to catch pieces of broken plaque.

A 2020 study suggested that strokes after carotid stenting were most likely in people older than 70 years. The study authors said most carotid-stenting-related strokes did not cause significant disability.

Doctors more commonly recommend carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. It is an open procedure that involves removing this plaque through a surgical cut in the neck.

However, a doctor may suggest stenting instead if the following apply:

  • An individual has received radiation treatment or surgery on the neck.
  • The plaque is in a location that is difficult to reach.
  • A person has severe lung, heart, or blood vessel issues.

Stenting is less invasive, as it does not involve a cut in the neck.

A 2023 article on the two procedures found that carotid stenting compares with CEA in the following ways:

  • The cuts are smaller during stenting.
  • An individual usually experiences less pain after stenting.
  • Stenting has a lower risk of complications with the wound after the operation.
  • Stenting requires a shorter stay in the hospital.

According to a 2020 meta-review of 22 trials with data from 9,753 people, carotid stenting may have links to a higher risk of stroke than CEA.

However, in the long term, both can be equally effective in preventing stroke due to carotid stenosis.

Is carotid stenting a major surgery?

Carotid stenting is minimally invasive. However, doctors still recommend a night of recovery in the hospital so they can monitor vital signs and catch any complications early.

How long does it take to recover from a carotid artery stent?

No research data on the recommended recovery time after a carotid stenting is available. People should speak with their physician about the recommended recovery time for their age, activity levels, and overall health.

Is a person awake during carotid stenting?

Doctors use local anesthetic during carotid stenting to induce relaxation and numbness, but the person will remain fully conscious during the procedure.

Carotid stenting is a procedure to treat carotid artery stenosis and reduce a person’s risk of stroke.

During the procedure, a doctor inserts a catheter into an artery via the groin, inflates a balloon to widen the carotid artery after threading it through, and inserts a stent to hold the blood vessel open.

Doctors more often recommend a carotid endarterectomy (CEA), which is more invasive and involves a cut in the neck. Not everyone is a good candidate for this, so stenting can be an equally effective alternative for some people.

Stenting requires less time in the hospital, involves shorter recovery time, and causes less pain than a CEA.

However, carotid stenting risks pieces of plaque breaking off and increasing stroke risk. A doctor can fully advise an individual on the benefits and possible risks of the procedure so that they can make an informed decision about their treatment plan.