Carotid artery stenting: a Cath Lab 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Carotid stenting in one minute
What it is: placing a stent in a narrowed carotid artery in the neck, which supplies blood to the brain, through a catheter.
Who it is for: some people with a significant carotid narrowing, often after a stroke or mini-stroke, especially if surgery is higher risk.
Main risks: stroke during or after the procedure, a slow heart rate or low blood pressure, bleeding at the access site and, rarely, heart attack.
Usually: under local anaesthetic so you can be checked during it, 1–2 hours, one or two nights in hospital.
On this page: What is carotid stenting? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in the lab? · FAQ
What is carotid stenting?
The carotid arteries run up each side of the neck to the brain. A narrowing can throw off debris and cause a stroke or TIA.
Two main treatments exist: surgery (carotid endarterectomy) and stenting. In stenting:
- a catheter is passed from the groin (or wrist) to the neck
- a protection device is usually placed beyond the narrowing
- the narrowing is opened with a self-expanding stent and balloon
A stroke and vascular team decides which treatment is best.
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- carotid narrowing after a stroke or TIA
- people for whom surgery is higher risk, for example after neck radiotherapy
- selected people without symptoms, after specialist review
The decision is made by your heart team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
It can be planned in advance or done urgently. Before it, you usually have:
- blood tests, including kidney function and blood count
- an ECG, and often an echo or other scan
- a review of your medicines, especially blood thinners and diabetes medicines, as per centre protocol
- a chance to ask questions and give consent
Step by step
1. Getting ready
You lie on the X-ray table. ECG, blood pressure and oxygen levels are monitored. The skin over the access site is cleaned and numbed with local anaesthetic; some people also have light sedation, as per centre protocol.
2. Access
A sheath is placed in the femoral artery (or radial artery), sizes per device and operator. Heparin is given, as per centre protocol. You stay awake so the team can check your speech and movement.
3. Stenting
- A. Guide to the neck. A long sheath or guide is placed in the carotid artery.
- B. Protection. A filter is opened beyond the narrowing.
- C. Stent. A self-expanding stent is placed and ballooned.
- D. Retrieve. The filter is removed and the result checked.
The team will ask you to speak and squeeze a toy during the procedure to check your brain is working normally.
4. Finishing
A final angiogram checks the result. The sheath is removed and the wrist closed with a pressure band, or the groin with pressure or a closure device, per device and operator.
Recovery and aftercare
- First hours: close checks of blood pressure, heart rate, the access site and neurological checks, as per centre protocol.
- Hospital stay: usually one or two nights.
- Medicines: blood thinners and a statin, as prescribed.
- Driving: follow DVLA guidance and your team's advice.
- Follow-up: ultrasound scan of the neck and clinic review.
Call 999 if you have chest pain, breathlessness, fainting, signs of a stroke, or heavy bleeding or swelling at the access site.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- stroke or TIA
- slow heart rate or low blood pressure (often brief)
- bleeding or bruising at the access site
- headache
- narrowing again later
- heart attack (rare)
Cath lab kit list (printable)
Barts example kit list
An example from one UK centre, written generically. Every lab has its own protocol, and sizes and doses vary.
- arterial sheath, size per device and operator
- long sheath or guide for the carotid, per operator
- guidewires, per operator
- embolic protection device, per device and operator
- self-expanding carotid stent, size per device and operator
- balloons, per operator
- medicines for slow heart rate, as per centre protocol
- heparin, as per centre protocol
Procedural steps (Barts example)
- Baseline neuro check
- Access; heparin
- Long sheath to the common carotid
- Protection device beyond the lesion
- Stent; post-dilatation; watch heart rate
- Retrieve protection; final angiogram; neuro check
First time in the cath lab?
đź’ˇ First-time tip
- Neuro checks. Ask the patient to speak and squeeze at set times.
- Heart rate drops. Have medicines ready for slow rates.
- Squeeze toy. Give it to the hand on the opposite side.
- Log timings. Record deployment and inflation times.
FAQ
Why stay awake?
So the team can check your brain is working normally.
Is it better than surgery?
It depends on the person; your team will advise.
Will I stay in hospital?
Usually one or two nights.
Related Cath Lab 101 guides
Sources
All checked on 10 October 2026. Each page's own date is shown where it gives one.
- NHS. Carotid endarterectomy and carotid stenting. nhs.uk/conditions/carotid-endarterectomy
- NICE. Stroke and TIA in over 16s (NG128). nice.org.uk
- StatPearls (NCBI Bookshelf), search: carotid artery stenting. ncbi.nlm.nih.gov/books
Disclaimer
Education only. This page is for general education for healthcare students, cath lab staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, heart team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a heart emergency, call 999.
Disclosure: I work for a company that makes a device used in this procedure. This page is independent education, isn't sponsored or reviewed by any company, and doesn't recommend any product.
All diagrams on this page are original illustrations created for rodnieoro.com.
