Carotid Angioplasty and Stenting (CAS)

Carotid angioplasty and stenting (CAS) is an alternative surgical procedure performed in some patients where carotid endarterectomy cannot be performed. This includes patients with a significant risk of death from the procedure such as patients with advanced heart disease and patients with a previous neck surgery. In cancer patients undergoing radiation therapy of the neck, CAS is preferred over carotid endarterectomy.

CAS is a relatively less invasive procedure where a catheter is introduced into an artery through a small incision over the groin and is gradually advanced towards the blockage in the carotid, under fluoroscopic guidance. A tiny balloon is guided to the area of the blockage and inflated to widen the artery and increase blood flow. Carotid angioplasty is often combined with the placement of a stent, a tiny mesh tube, which is left inside the artery.  This widens the artery and restores the blood supply to the brain. The stent helps maintain the patency of the artery and prevents it from future narrowing.

Risks and complications of CAS includes infection, serious bleeding due to rupture of artery during catheter manipulation, embolic stroke due to accidental release of plaque fragments during the procedure, blood clots and heart attack. A small risk of seizures and strokes also exists.