Doctors diagnose millions of people each year with atherosclerosis, a dangerous condition that almost always requires some treatment. Vascular disease is a serious diagnosis and worrisome especially when in a major vessel such as the carotid artery.

How Does Atherosclerosis Happen?

The carotid artery is the major blood vessel in your neck supplying oxygen to your brain, neck, and face. When fatty deposits stick to the vessel wall, plaques form and grow inward, slowly narrowing the space and consequently decreasing blood flow, a condition known as carotid stenosis. The more stenosis there is, the higher chance of dangerous blood clots forming.

If left untreated, carotid narrowing can cause a variety of problems including,

  • Dizziness
  • Stroke
  • Hardening of the arterial wall
  • Blood clots

You can help prevent these fatty plaques through a good exercise regimen and healthy eating. The more fats you consume, the higher your cholesterol levels. Consistently high cholesterol levels lead to more plaque build-up.

Fortunately, there are ways to treat this condition using interventional cardiovascular medicine. Placing a carotid stent in the space opens it up and thus reestablishes normal blood flow. Carotid endarterectomy is an open surgical procedure that removes the plaques completely. These both have high success rates.


There is always a chance that there will be stenosis of the carotid again, even after a procedure to correct it. Plaques form above, below, or through the mesh stent, narrowing the space again. Plaque buildup again causes the mesh to become embedded inside the plaque, making it harder to eliminate the problem. The doctor must deal with this issue, as leaving a restenosis alone can easily lead to stroke.

Researchers have found that as many as 33% of stenting patients end up with restenosis, usually diagnosed within the first year after the initial procedure.

Researchers have found that as many as 33% of stenting patients end up with restenosis, usually diagnosed within the first year after the initial procedure.

Treatment Options

When it comes to treatment, the method of interventional cardiovascular medicine will be determined by your physician and can include the following

Carotid Endarterectomy

This procedure is a surgical intervention in which your doctor makes a small incision in the neck directly above your carotid artery. The doctor bypasses the delicate nerves in the neck. The doctor then cuts open the carotid artery and strips out the stent plus any plaques that have invaded it. It is the most common option when it comes to carotid in-stent restenosis.

Percutaneous transluminal angioplasty

According to the National Center for Biotechnology Information, this procedure is the most commonly used and is a less-invasive approach than an endarterectomy. Your physician will put a catheter wire into your femoral or brachial artery and guide it directly into the carotid artery. The doctor may then decide on one of the following approaches.

Cutting balloon

A small deflated balloon device will be placed at the plaque site, then inflated to push the plaques against the vessel wall, opening the space. A cutting balloon has tiny, sharp cutting edges on its outside that help score the plaques, compressing them inward with less pressure than a standard balloon. In the case of restenosis, cutting balloons are used only on rare occasions, as there is a risk of the cutting surface becoming entangled in the mesh stent already in place.

Drug-laced balloon

When the drug-laced balloon deploys at the site of restenosis, pores on the balloon’s lining open up, releasing medication directly into the plaque and vessel wall. Drugs vary, but all have the purpose of preventing further restenosis.


In some cases, the doctor may decide to insert a brand-new carotid stent, using catheterization. The plaque and previous stent are compressed against the vessel walls and a new stent expanded inside the old one. This procedure, although not commonly used in the case of restenosis, is in some situations the best option.

In Conclusion

One common trait these procedures share is the ability to reestablish blood flow and compress or remove plaques. It is an exciting time of modern medicine in which we live.

Just to think that when there is a dangerous buildup of plaque in such a major artery the doctor and fix this health hazard with a variety of procedures. When it comes to carotid in-stent restenosis, there is much to learn, and much that can be done to treat it.

Categories: Health Issues

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