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UrduCarotid artery stenosis (narrowing of the neck arteries supplying the brain) can be treated without open surgery through a minimally invasive procedure called carotid artery stenting. A self-expanding metal stent is placed inside the artery via a small wrist or groin puncture under local anaesthesia. A cerebral embolic protection device is used to prevent stroke during the procedure. Current guidelines recommend intervention for symptomatic stenosis of 50 to 99% (especially within 2 weeks of TIA) and for asymptomatic stenosis of 70 to 99% in selected patients. Randomised trials (CREST, ACT I) show outcomes comparable to open surgery in experienced hands.
A stroke does not always happen without warning. In many patients, the body gives a chance to prevent it. One of the most important warning signs is narrowing of the carotid arteries, a condition that can now be treated through a minimally invasive procedure without open neck surgery.
What Are the Carotid Arteries and Why Does Their Narrowing Matter?
The carotid arteries are the two major blood vessels on either side of the neck that supply oxygen-rich blood to the brain. Over time, cholesterol, calcium, and inflammatory deposits form atherosclerotic plaques inside these arteries. As plaques grow, the artery narrows and blood flow to the brain reduces. A plaque can also rupture, releasing tiny particles that travel to the brain and trigger a stroke before the artery is fully blocked.
This process, called carotid stenosis, accounts for 15 to 20% of all ischaemic strokes. Many patients have no symptoms until a stroke or TIA occurs, making screening important for anyone with high blood pressure, diabetes, smoking, high cholesterol, or a family history of stroke.
Warning Signs That Should Never Be Ignored
Some patients develop warning symptoms before a major stroke called Transient Ischaemic Attacks (TIA) or mini-strokes: sudden weakness or numbness on one side of the body, temporary vision loss in one eye (like a curtain falling), difficulty speaking, facial drooping, dizziness, or sudden imbalance.
TIA symptoms resolve within hours, which is why patients often dismiss them. This is dangerous. A TIA is a medical emergency: stroke risk in the 48 hours following a TIA is at its highest. Immediate assessment at The Vascular Center can prevent a disabling event.
How Is Carotid Narrowing Diagnosed?
Diagnosis begins with a carotid Doppler ultrasound, a non-invasive study that identifies the degree of narrowing and plaque characteristics. When further detail is needed, CT angiography, MR angiography, or Digital Subtraction Angiography (DSA) provide precise anatomical roadmaps for treatment planning.
At The Vascular Center, all imaging is reviewed personally by Dr Amol Lahoti before any recommendation is made.
When Is Treatment Recommended?
Best medical therapy is the foundation for all patients: antiplatelet medications, statins, blood pressure control, diabetes management, and smoking cessation. For mild to moderate narrowing, this is sufficient.
When narrowing becomes significant, revascularisation is added. Guidelines support intervention for symptomatic stenosis of 50 to 99%, particularly within two weeks of TIA or stroke, when benefit is greatest. For asymptomatic patients, intervention is considered at 70 to 99% stenosis in selected individuals with reasonable life expectancy, low procedural risk, and high-risk imaging features.
Dr Amol Lahoti is an Endovascular Specialist at The Vascular Center, Century Multispecialty Hospital, Chhatrapati Sambhajinagar (Aurangabad). He trained in Vascular and Interventional Radiology at LTMGH Sion Mumbai and holds Certified Chemoembolization training from Tata Memorial Hospital, Parel, Mumbai. He is a member of IRIA, ISVIR, APSCVIR, ESOR, SPIR, and SIR, with 9 indexed publications and international presentations at PAIRS 2019 Dubai and APSCVIR 2019 Bali. Contact: +91 9971121273 | Website: dramollahoti.com.
What Is Carotid Artery Stenting and How Is It Performed?
Traditionally, carotid narrowing was treated with carotid endarterectomy, which requires general anaesthesia and a neck incision. Carotid artery stenting is a minimally invasive alternative, especially for patients at increased surgical risk due to previous neck surgery, prior radiation, recurrent stenosis, severe cardiac or pulmonary disease, or complex anatomical factors.
The procedure is performed under local anaesthesia through a small puncture at the wrist or groin, with catheters and guidewires navigated into the carotid artery under fluoroscopic guidance.
The most critical safety step is placement of a cerebral embolic protection device beyond the stenosis before any plaque manipulation. This filter captures dislodged fragments and significantly reduces procedural stroke risk. Pre-dilatation with a small balloon may follow. A self-expanding nitinol stent is then deployed across the narrowed segment, compressing the plaque and restoring smooth blood flow. Post-dilatation optimises expansion under continuous neurological monitoring. A final angiogram confirms the result.
Most patients go home the following day. Large randomised trials including CREST and ACT I confirm that in appropriately selected patients, carotid stenting by experienced operators delivers outcomes comparable to open endarterectomy.
Recovery and Long-Term Care After Stenting
After the procedure, dual antiplatelet therapy continues for the recommended duration, then lifelong single antiplatelet therapy. Statins, blood pressure control, diabetes management, and smoking cessation remain essential to slow atherosclerosis.
Follow-up carotid Doppler at regular intervals monitors stent patency and detects any restenosis early. Stroke prevention is always more effective than stroke treatment, and sustained medical therapy is as essential as the procedure itself.
Consult Dr Amol Lahoti at The Vascular Center
If you or a family member has experienced a TIA, been told of carotid narrowing on a Doppler scan, or carries multiple cardiovascular risk factors, an expert vascular evaluation is essential.
Dr Amol Lahoti, Endovascular Specialist trained at LTMGH Sion Mumbai and Tata Memorial Hospital, provides carotid stenting and complex endovascular care in Chhatrapati Sambhajinagar. Visit dramollahoti.com.
Call +91 9971121273 or 0240 247 2281 to schedule your consultation at The Vascular Center, Century Multispecialty Hospital, Aurangabad.
FREQUENTLY ASKED QUESTIONS
Q1: What is carotid artery stenting?
Carotid artery stenting is a minimally invasive procedure in which a small metal mesh tube (stent) is placed inside a narrowed carotid artery to compress the plaque, widen the artery, and restore blood flow to the brain. It is performed through a small puncture in the wrist or groin under local anaesthesia, without open neck surgery.
Q2: Who needs carotid artery stenting?
Stenting is considered for patients with symptomatic carotid stenosis of 50 to 99% (especially within two weeks of a TIA or stroke), or asymptomatic stenosis of 70 to 99% in carefully selected patients. It is particularly useful for those at high surgical risk for open endarterectomy due to anatomical, cardiac, or pulmonary factors.
Q3: Is carotid stenting safer than open surgery?
In appropriately selected patients treated by experienced interventionalists, carotid stenting provides comparable stroke prevention outcomes to open carotid endarterectomy. Stenting avoids the risks of general anaesthesia and a neck incision, which makes it the preferred approach for high surgical risk patients.
Q4: What is a TIA and why is it an emergency?
A Transient Ischaemic Attack (TIA) or mini-stroke causes temporary neurological symptoms such as limb weakness, speech difficulty, or temporary vision loss that resolve within minutes to hours. Although symptoms resolve, the risk of a major stroke in the days following a TIA is very high. A TIA must be treated as a medical emergency.
Q5: Is carotid artery stenting painful?
The procedure is performed under local anaesthesia and is not painful. Patients may feel mild pressure at the access site. The procedure typically takes 60 to 90 minutes and patients are monitored overnight in the hospital before going home the next day.
Q6: What is the cerebral embolic protection device?
A cerebral embolic protection device is a small filter placed in the carotid artery beyond the plaque before any treatment begins. It catches any plaque debris that may break off during the procedure, preventing these fragments from travelling to the brain. It is a critical safety step that significantly reduces stroke risk during stenting.
Q7: How long does recovery take after carotid artery stenting?
Most patients go home the day after the procedure. Physical activity can typically be resumed within a few days. Return to full normal activity, including light exercise, usually occurs within one to two weeks. Heavy lifting and strenuous exercise are avoided for a short period as advised by the treating specialist.
Q8: What medications are needed after carotid stenting?
Dual antiplatelet therapy (typically aspirin plus clopidogrel) is prescribed for a recommended duration after stenting. This is followed by lifelong single antiplatelet therapy. High-intensity statins, blood pressure control, and other cardiac risk factor management remain essential long term.
Q9: Can carotid stenosis recur after stenting?
In-stent restenosis, where the artery narrows again inside the stent, is uncommon but possible. Regular follow-up with carotid Doppler ultrasound detects this early. Risk is minimised through strict adherence to antiplatelet therapy, statin therapy, and cardiovascular risk factor control.
Q10: Where can I get carotid artery stenting done in Aurangabad?
Dr Amol Lahoti, Endovascular Specialist at The Vascular Center, Century Multispecialty Hospital, Chhatrapati Sambhajinagar, provides carotid artery stenting and comprehensive vascular care. Call +91 9971121273 or 0240 247 2281 to schedule a consultation, or visit dramollahoti.com.
This article is authored by Dr Amol Lahoti, Endovascular Specialist with training from LTMGH Sion Mumbai and Tata Memorial Hospital. The content references the CREST trial (NEJM 2010), ACT I trial (NEJM 2016), and 2023 ESVS guidelines on carotid artery disease management.