Carotid Stenting

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Carotid Stenting

Vascular Experts Treat Blocked Carotid Arteries Without Surgery to Prevent Stroke.  A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is blocked by a clot or bursts, causing the brain to starve. If deprived of oxygen for even a short period of time, the brain nerve cells will start to die. Once the brain cells die from a lack of oxygen, the part of the body that section of the brain controls is affected through paralysis, difficulty speaking, loss of motor skills, or vision.

Stroke Prevalence

• Stroke is third leading cause of death in United States, behind high blood pressure and cancer
• Every 45 seconds someone in the United States has a stroke
• Every three minutes someone dies from a stroke

There Are Two Main Types Of Stroke

Ischemic Stroke: Strokes caused by blood clots that block the artery are ischemic (is-KEM-ik) strokes. This is the most common type, accounting for 70-80 percent of all strokes.

Hemorrhagic Stroke: When a blood vessel ruptures, it causes a bleeding or hemorrhagic (hem-o-RAJ-ik) stroke. The vessels and brain around the bleeding area are starved of oxygen as the blood compresses the structures and prevents blood from entering or exiting tissue.

"Mini-Strokes" There are also "mini-strokes" known as TIA's (transient ischemic attacks).  By definition, TIAs are small strokes that are temporary and resolve when the body breaks up the small clots in the brain causing the symptoms.  People who have one TIA are very likely to have another one.  People often ignore these symptoms, but they are an early warning sign and 35 percent of those who experience a TIA will have a full blown stroke if left untreated. TIAs should be taken as seriously as stroke.

The Most Common Symptoms of Stroke are:

• Sudden numbness or weakness in the face, arm and/or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding speech.
• Sudden trouble seeing, including double vision, blurred vision or partial blindness, in one or both eyes.
• Trouble walking, dizziness, loss of balance or coordination.
• Sudden severe, headache with no known cause.

If you experience any of these symptoms, even if they go away quickly, seek immediate emergency help.

Every minute counts. Although starved of oxygen, brain tissue does not die in the minutes following a stroke. If blocked blood vessels can be opened within three to six hours, the chances of recovery are greatly improved.

Risk Factors

• Obesity, high blood pressure and high cholesterol all increase the risk of stroke. These risk factors can be greatly reduced with healthy lifestyles or medication.
• High blood pressure puts pressure on the arteries, making them more susceptible to rupture and more prone to clot formation, which can block the artery.
• High cholesterol can lead to blockage in the carotid artery that takes blood from the neck to the brain. A piece of this plaque can break off and travel to the brain, causing a stroke.
• Obesity can cause high blood pressure and high cholesterol.
• Untreated atrial fibrillation causes the heart’s upper chamber to beat irregularly, which allows the blood pool and clot. If a clot breaks off and enters the blood stream to the brain, a stroke will occur.
• Sickle cell anemia makes red blood cells less able to carry blood to the body’s tissues and organs, as well as stick to the walls of the blood vessels. These cells can block arteries to the brain, causing a stroke.
• Family history
• Smoking

Prevention and Carotid Stenting

As vascular experts, interventional radiologists treat atherosclerosis, "hardening of the arteries," throughout the body. In some patients, atherosclerosis, specifically in the carotid artery in the neck, can lead to ischemic stroke. Plaque in the carotid artery may result in a stroke by either decreasing blood flow to the brain or by breaking loose and floating into a smaller vessel, depriving a portion of the brain of blood flow. In patients at high risk of having a stroke, the narrowed section of artery may be reopened by an interventional radiologist through angioplasty and reinforced with a stent, thereby preventing the stroke from occurring. Vascular stents are typically made of woven, laser- cut or welded metal that permits the device to be compressed onto a catheter and delivered directly into the hardened artery. In addition to diagnosing and treating those at risk for stroke, interventional radiologists use their expertise in imaging, angioplasty and stenting to treat those having an acute stroke.

The physicians at FIS were chosen as one of 110 centers in the US to be included in the National Institute of Health trial comparing carotid stenting to carotid endarterectomy in patients who have a narrowing of their carotid artery with or without symtoms. The landmark NIH trial, called CREST (Carotid Revascularization Endarterectomy versus Stenting Trial) is the largest randomized clinical trial comparing the 2 treatment options for patients with carotid artery disease. Enrollment is now complete and preliminary results suggest equivalent overall safety and efficacy for both procedures however investigators found that there were more heart attacks in the surgical group and more strokes in the stenting group.  FIS doctors have placed over 300 carotid stents since 1996, more than most practices in the country.

 Patients can also take action to prevent strokes by:

• Stop smoking
• Controlling high blood pressure
• Lowering cholesterol levels
• Maintaining healthy weight
• Exercising
• Utilizing appropriate medications like aspirin, prescription drugs like anticoagulants
• Treating carotid artery disease
• Treating unruptured cerebral aneurysm or arteriovenous malformation

Source: 2012 Society of Interventional Radiology http://www.sirweb.org/patients/stroke/