Alternatives to carotid endarterectomy 

Carotid endarterectomy is the main treatment for narrowing of the carotid arteries as it's very effective.

However, there's also an alternative procedure called carotid artery stent placement, or "stenting".

Carotid artery stent placement

Carotid artery stent placement is less invasive than a carotid endarterectomy because it doesn't involve a cut being made in the neck.

Stenting is carried out under local anaesthetic and involves a narrow flexible tube called a catheter being inserted into an artery in your groin. It's then threaded up into the carotid artery using X-rays to guide it into place.

A small balloon at the end of the catheter is inflated to around 5mm at the site of the narrowed artery, and a small mesh cylinder called a stent is then inserted. The balloon will be deflated and removed, leaving the stent in place to keep the artery open and allow blood to flow through it.

After the procedure, you'll need to lie flat and keep still for about an hour to prevent any bleeding from the artery. You'll need to stay in hospital overnight, but will be able to return home the next day.

Like carotid endarterectomy, there are some risks associated with stenting. The risk of having another stroke or dying is slightly higher than after carotid endarterectomy, especially when the procedure is performed soon after symptoms appear. But the long-term outcomes from a successful procedure are no different from a carotid endarterectomy.

The decision about which procedure you'll have will be made based on your own personal wishes, your overall fitness, and an assessment of your clinical history. One major factor is how long it's been since your most recent symptom.

NICE guidelines

The National Institute for Health and Care Excellence (NICE) has confirmed stenting is a safe procedure and has good short-term results.

Evidence suggests a successful stent procedure has the same long-term risks of a stroke as carotid endarterectomy.

NICE advises that, provided the risks of stenting are judged similar to those after surgery, it's safe to offer this alternative. 

Read the NICE guidance on carotid artery stent replacement for symptomatic extracranial carotid stenosis.

Page last reviewed: 20/08/2015

Next review due: 20/08/2017