Angioplasty and Stenting of the Carotid and Other Cerebral Arteries

Carotid occlusive disease, also called carotid stenosis, occurs when one or both of the carotid arteries in the neck, which supply blood to the brain, becomes narrowed or blocked. The narrowing usually is the result of the buildup of plaque — a fatty deposit containing blood platelets — along the vessel wall. If a piece of the plaque breaks off and blocks one of the arteries in the brain itself, blood flow to the brain is compromised, causing a transient ischemic attack (TIA or "mini-stroke") or, if there is significant blockage of the artery, a stroke.

Treatment

In many cases, endarterectomy, the surgical removal of the carotid plaque, is used to treat this condition. However, some patients might not be candidates for surgery, or the site of the occlusion may be out of reach of normal surgical procedures. Interventional neuroradiologists can use angioplasty and stenting as an alternative to surgery for these patients. Commonly used in other parts of the body, including coronary and renal arteries, angioplasty is minimally invasive and has good success rates.

Like other interventional neuroradiology procedures, angioplasty and stenting involve the insertion of a tube, or catheter, in an artery in the groin. The catheter then is guided up through the blood vessels to the point of the occlusion. The catheter then deploys a small balloon at the site of the blood clot. This disrupts the buildup and expands the artery to improve blood flow. Angioplasty procedures often are accompanied by stenting. A stent is a small metallic mesh tube that self-expands to hold the artery open and maintain blood flow. The stent helps prevent restenosis, or the re-accumulation of plaque at the same site.