Carotid Stenting: An Advanced Procedure That May Help Prevent Strokes

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There is good news for patients with carotid artery disease -- MMH offers an advanced procedure called carotid stenting to treat this condition and reduce the risk for strokes. Performed by Gino Sedillo, MD, FACC, and Enrique Rivera, MD, carotid stenting is a minimally invasive catheterization procedure to reduce the buildup of fat and cholesterol deposits, called plaque, on the insides of carotid arteries. Plaque buildup in carotid arteries, the large vessels on either side of the neck that carry blood from the heart to the brain, is especially dangerous and may put a patient at risk for a stroke if:

• An artery becomes extremely narrowed.
• A piece of plaque breaks off and travels to the smaller arteries of the brain.
• A clot forms and blocks a narrowed artery.

Traditional surgical treatment is called a carotid endarterectomy, which involves cutting into the artery to remove the plaque. During a carotid stenting procedure, which is less invasive, the interventional cardiologist places a stent (a tiny, mesh tube) into the carotid artery to flatten the plaque and keep the blood vessel open.

"Carotid endarterectomy is still the ‘gold standard' procedure, but carotid stenting is particularly useful for high-risk patients who can't have traditional surgeries," Dr. Rivera says.

You may be a candidate for carotid stenting if:

• Carotid endarterectomy is considered too risky for you.
• Your carotid artery is narrowed by more than 60 percent and you have had symptoms of a mini-stroke or stroke.
• You have no stroke symptoms but your carotid artery is narrowed by more than 80 percent and carotid endarterectomy is considered too risky for you.
• You have developed a new narrowing after previous carotid surgery.

How Carotid Stenting Works To begin the carotid stenting procedure, the cardiologist threads a long, thin catheter from a small incision in the groin to the site of the blockage in the neck.

A protection device that resembles a tiny umbrella is threaded through the artery and placed just above the blockage site to catch clots or debris, while allowing blood to pass through to the brain. Acting as a filter, the device prevents the clots or debris from traveling to the brain, where they may cause a stroke.

The cardiologist then threads a tiny balloon to the blockage site and inflates it, flattening plaque against the artery walls. The stent is inserted next, and the cardiologist uses another balloon to help it expand and dilate the artery. After the stent is placed, the balloon and protection device are removed. The stent widens the passage and allows blood to flow through more freely. It also serves as a scaffold for a healthy new artery lining.

Carotid stenting has advanced since it was first introduced years ago, according to Dr. Sedillo. "The protection system, which is the primary innovation, greatly reduces the chance for a stroke as a result of the procedure," he says.

"The medical community is evaluating both procedures to see if carotid stenting has similar or better results compared with carotid endarterectomy in low-risk patients," Dr. Rivera says. "I think the data will show that carotid stenting should be the preferred surgical treatment for carotid artery disease."

"Someday, perhaps all blockages in carotid arteries will be treated with minimally invasive carotid stenting," Dr. Sedillo says.

For more information about carotid stenting at Manatee Memorial Hospital, please call 941-745-7572.

Enrique Rivera, MD The Heart and Vascular Center 2101 61st St. West Bradenton, FL 34209 941-761-4448

Gino Sedillo, MD, FACC Co-Director, Cardiac Cath Lab at Manatee Memorial Hospital Bradenton Cardiology 316 Manatee Ave. West Bradenton, FL 34205 941-748-2277

206 Second Street East, Bradenton, FL 34208 941-746-5111 FAX: 941-745-6862