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Carotid Artery Repair: Stent Or Scalpel?Dr. Salloum is Cardiology Fellow, Division of Cardiovascular Medicine, and Dr. Campbell is Assistant Professor of Neurology, Division of Interventional Neurology, The University of Texas Medical School at Houston and The Memorial Hermann Heart Center, Houston, Texas.
Sometimes, the progress of a new medical technique is a little like the rise of a new boxing champion. It is not enough for a young challenger to be more exciting, more promising — even a little bit better — than the champ. Before a newcomer can be accepted, the reigning champion must be clearly and decisively defeated. In medicine, doctors tend to stick with a tried and true traditional procedure until an innovative new technique is conclusively shown to be superior. Such seems to be the case with the treatment of carotid artery disease. Carotid artery disease typically begins with narrowing caused by the buildup of plaque inside the artery. The traditional way of dealing with the blockage is to perform a type of surgery called carotid artherectomy (also called carotid endarerectomy), which involves cutting out and repairing part of the artery. There is, however, a new less invasive technique called carotid stenting, in which a tube-shaped piece of material is inserted into a damaged artery to help it do its job of maintaining adequate blood flow. For many people, carotid stenting appears to be safer and more effective.The question today is whether stenting should replace carotid artherectomy as the standard treatment. One of the body's largest blood vessels, the carotid artery carries blood from the heart to the head and brain. Like any artery, it is subject to internal plaque buildup that can cause atherosclerosis (narrowing), blockages and other types of damage, all of which can interrupt blood flow to the brain. This interruption can produce a TIA (Transient Ischemic Attack, a precursor to stroke), stroke or even death. TIAs most commonly occur in the middle-aged or elderly, appearing and disappearing suddenly, lasting anywhere from a minute to several hours. Symptoms include confusion, vertigo, and vision or speech problems but not loss of consciousness. It is estimated that 25% of the 500,000 strokes that occur yearly in the United States are caused by atherosclerosis of the carotid artery. The current medical consensus is to treat this with carotid artherectomy surgery, combined with drugs.(1) In this Corner: "The Champion"
Carotid artherectomy is a very serious operation. It involves a surgical incision in the neck, opening up the carotid artery and "coring out" fatty plaque deposits, as well as, in many cases, a section of the artery itself. Before the operation, doctors measure the extent of the blockage by doing a test called an arteriography, in which a radioactive opaque dye is injected into the bloodsteam. This allows doctors to see how an area of narrowing or other damage is affecting blood flow through the carotid artery to the brain.
As with any surgery, carotid artherectomy carries a degree of risk which has to be weighed against its benefits. The benefits are clear - a successful operation will eliminate symptoms and reduce a person's risk of suffering a TIA or stroke. As for the risks, follow up studies on people who have undergone this operation have shown that the likelihood of suffering a serious health complication after surgery is about 2.6%. In other words, out of 100 people who have this surgery, between two and three persons will have a serious complication. This figure includes a death rate of 1.1%, a 0.9% chance of suffering from a disabling stroke after the operation; and a 4.5% chance of a non-disabling stroke.(2) The current medical consensus is that so long as the overall complication rate remains below 3%, carotid endartherectomy is beneficial for most patients who have at least a 60% narrowing of their carotid artery.(3) One important point to keep in mind, however, is that these statistics are based on surgeries performed by particularly highly skilled surgeons on healthier than average patients. For both reasons, these statistics may underestimate the down side of carotid artherectomy for the average person.
(4) Comments have been made CHARLES
I HAD THE CAROTID SURGERY AND I HAVE A LONG WAY TO GO WITH MY LEFT ARM AND LEFT LEG THERAPY BUT I FEEL I AM VERY FORTUNATE TO BE ALIVE TODAY. I AM ON A HEART HEALTHY DIET NOW - THATS FOR SURE!!Posted Fri, Feb. 26, 2010 at 9:53 am EST
trevorstohr
howlong canyou start driving again after stantsoperationPosted Wed, Feb. 24, 2010 at 10:06 am EST
trevorstohr
concern of having trebelbypass and not work as adietbectec and kindy troubleis this more higherPosted Wed, Feb. 24, 2010 at 9:59 am EST
Anonymous
Most carotid endarterectomy patients go home the next day. Well tolerated procedure even in high risk patients. Can be done under regional anesthetic.Posted Wed, Feb. 3, 2010 at 2:53 pm EST
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