What you can expect

Carotid angioplasty is considered a nonsurgical procedure because it's less invasive than surgery. Your body isn't cut open except for a very small nick in a blood vessel in your groin.

Most people don't need general anesthesia and stay awake during the procedure. However, some people may not stay awake based on their anesthesia and how sleepy they feel. You'll receive fluids and medications through an IV catheter to help you relax.

Before the procedure

• You're taken to an X-ray imaging room and asked to lie on a procedure bed. You'll rest your head in a cup-shaped area to help you remain comfortable and still while pictures of the carotid artery are taken.
• Your groin is shaved and prepared with antiseptic solution, and a sterile drape is placed over your body.
• A local anesthetic is injected into your groin to numb the area.
• Small electrode pads are placed on your chest to monitor your heart rate and rhythm during the procedure.

During the procedure

Once you're sedated, your doctor makes a puncture in an artery, usually the femoral artery in the groin area. The following describes the angioplasty and stenting procedure.

• A small tube (sheath) is placed into the artery. A catheter with a balloon tip is then threaded through the tube to the narrowing in the carotid artery under X-ray guidance. You won't feel the catheter passing through the arteries because the insides of arteries don't have nerve endings.
• Contrast material is injected into the carotid artery through the catheter. The contrast material may cause a temporary warm feeling on one side of your face. Contrast material provides a detailed view of the narrowed artery and blood flow to the brain.
• A filter is placed in the artery. The filter, called an embolic protection device, is inserted beyond the narrowing to catch any debris that may break off from the narrowed area of artery during the procedure.
• The balloon tip is threaded into the narrowed area and inflated to push the plaque to the side and widen the vessel.
• A small metal mesh tube (stent) may be placed in the newly opened vessel. The expanded stent provides support that helps prevent the artery from narrowing again. The stent may be coated in a drug that is released slowly over time to help prevent restenosis.
• The filter, sheath, catheter and balloon are removed. Pressure is applied to the small catheter insertion site to prevent bleeding.

When the procedure is done, you lie still in one position while pressure is applied to the site to stop bleeding. You generally won't have stitches, but a dressing is applied to cover the small incision site. You'll then be taken to the recovery area.

After the procedure

To avoid bleeding from the catheter insertion site, you need to lie relatively still for several hours. You'll be either in the recovery area or in your hospital room. After the procedure, you may receive an ultrasound of your carotid artery. Most people are discharged from the hospital within 24 hours after the procedure.

The catheter site may remain tender, swollen and bruised for a few days. There may be a small area of discoloration or a small lump in the area of the puncture. You may take acetaminophen (Tylenol, others) in the recommended dose as needed for discomfort, or other medication as prescribed by your doctor.

You may need to avoid strenuous activity and heavy lifting for 24 hours after the procedure.