There are two procedures used to treat carotid artery disease. The standard surgical procedure is carotid endarterectomy (CEA), while the newer, minimally invasive endovascular intervention is called carotid artery angioplasty with stenting (CAS).
During CAS, a special catheter is inserted into the carotid artery to be treated. This catheter has a tiny balloon at its tip, which is inflated once the catheter has been placed into the narrowed area of the carotid artery.
The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow. A stent (a tiny, expandable metal coil) may be inserted into the newly-opened artery to help keep it from narrowing or closing again.
While there are some restrictions on the use of carotid angioplasty and stenting (CAS), the procedure is being performed more widely (Archives of Surgery, August 2007: 142(3); 736-737).
CAS is less invasive and studies have shown it to be as effective as CEA for the treatment of carotid stenosis (occlusion of the carotid artery, an artery in the neck which carries blood to the brain), particularly in patients who are at high risk for surgical treatment (Perspectives in vascular surgery and endovascular therapy, September 2007: 19(8), 228-230; Stroke, April 2002: 33(4); 1063-1070). However, CAS carries a significantly higher risk of microemboli (tiny clots) after surgery when compared to CEA (Journal of Endovascular Therapy, August 2007: 14(4); 561-567).
Because of the potential for clots to dislodge from the plaque into the circulation of the brain and possibly cause a stroke, there are now devices called embolic prevention devices (EPD) being used during CAS. One type of EPD has a filter-like basket attached to a catheter that is positioned in the artery to “catch” any clots or small debris that might break loose from the plaque during the procedure. This technique may help reduce the incidence of stroke during carotid angioplasty.