Synopsis
Explain safe selection, preparation, conduct, complications and follow-up of carotid artery stenting in UK adult practice.
- Carotid stenting is selected through specialist multidisciplinary comparison with endarterectomy; age, timing, arch and lesion anatomy, prior neck treatment, comorbidity and local audited outcomes all matter.
- For recently symptomatic patients needing revascularisation within fourteen days, endarterectomy is generally preferred over transfemoral stenting because early procedural stroke or death is higher with stenting, especially from age seventy.
- New deficit, severe headache, seizure, hypertension, bradycardia or hypotension around stenting demands immediate assessment for embolism, thrombosis, haemorrhage, hyperperfusion or haemodynamic instability.
Key red flags
New weakness, aphasia, visual loss or neglect during or after the procedure requires immediate neurological assessment and imaging.
Severe ipsilateral headache, seizure, hypertension or reduced consciousness after revascularisation raises cerebral hyperperfusion and intracranial haemorrhage.
Profound bradycardia or hypotension during ballooning can impair cerebral and coronary perfusion and needs prompt monitored treatment.
Acute neck swelling, stridor or tracheal deviation after transcarotid access threatens the airway and requires immediate surgical review.
Abrupt monocular loss, aphasia, neglect or contralateral weakness during wire passage or after deployment suggests thromboembolism or acute stent failure.
Bradycardia and hypotension during ballooning or after stenting reflect carotid-sinus stimulation and can compromise cerebral or myocardial perfusion.
New severe headache, seizure, hypertension, focal deficit or reduced consciousness after flow restoration requires urgent brain imaging and blood-pressure treatment.
Investigation priorities
Confirm stenosis severity, plaque location and flow while documenting the measurement criteria used.
Management branches
A patient has carotid disease for which revascularisation benefit is being considered.
- Confirm that symptoms are ipsilateral and attributable, quantify neurological disability and infarct burden, and verify stenosis with the stated NASCET-equivalent method.
- Compare expected benefit with the centre's procedural risk, then weigh age, timing, neck factors, cardiopulmonary risk, arch anatomy and lesion morphology.