Interventional procedure overview of transfemoral carotid artery stent placement for asymptomatic extracranial carotid stenosis

Indications and current treatment

The main arteries in the neck (the carotid arteries) can become narrowed by fatty deposits (extracranial carotid stenosis). Blood clots can form on these fatty deposits. Fragments can then detach and lodge in thinner arteries that supply blood to parts of the brain. This can cause a stroke or TIA (sometimes called a 'mini stroke'). If the carotid stenosis is not causing any health problems it is asymptomatic. It may be identified incidentally during imaging and investigations for other conditions, or during health screening.

For people with asymptomatic extracranial carotid stenosis, management includes lifestyle modification (diet, exercise, and smoking cessation) and pharmacological therapy (antithrombotics, lipid-lowering agents, blood pressure reduction, and glycaemic control). Some people with severe stenosis may be offered revascularisation and the conventional surgical approach used is CEA. This involves making an incision in the side of the neck to access the narrowed section of artery and remove the fatty deposits. A newer alternative approach is TCAR, which uses a transcarotid neuroprotection system. The common carotid artery is accessed directly, through a smaller incision than CEA. This procedure is not being considered in this overview. NICE's interventional procedures guidance on transcervical extracorporeal reverse flow neuroprotection for reducing the risk of stroke during carotid artery stenting was published in 2016.