In past decades, open surgery was the standard treatment for patients diagnosed with a build up of plaque in their carotid arteries. Recent advances in the management of vascular disease, however, may now see more patients looking at carotid stenting as a less invasive alternative to traditional open surgery. Dr. Brajesh Lal, a vascular surgeon at the University of Maryland Medical Center, answers some commonly asked questions about carotid stenting below.
What are stents?
Stents are little coils or spring-like structures that can be released within an artery to push the plaque out of the way and open up the artery to allow for increase blood flow. Stents have traditionally been used in the coronary arteries that supply blood to the heart and in the renal arteries that supply blood to the kidneys.
When were stents first used to treat blockages in the carotid arteries?
About a decade ago, we started investigating the potential use of stents in the carotid arteries. The Maryland Vascular Center was involved in some of the pioneering studies that tested the efficacy of this procedure and, very recently, the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), which was funded by the National Institutes of Health (NIH), reported its results comparing carotid endarterectomy to carotid stenting for relieving blockages in the carotid artery. I was the Director of Operations for this study which found that, in a specific subset of patients, carotid stenting worked equally well when compared to carotid endarterectomy.
How is this procedure performed?
Carotid stenting involves passing a wire into the arterial system, usually through an artery in the patient's groin, up through the big artery in your abdomen and thorax, and then passing it into the carotid artery. Surgeons use this wire to deliver a stent across the blockage. The procedure takes about one hour, and after the procedure there is a recovery period that lasts overnight.
Are there any risks associated with this procedure?
There is a small risk of a little piece of plaque dislodging during the procedure and causing a stroke; however, that risk is only in the range of three to four percent. We use a small filter device that we unfurl above the blockage to catch any debris that may be released during the procedure.
How successful has this procedure been?
We have had very good success with this procedure, and in addition to being part of the CREST trial, I have investigated the use of carotid stenting and published results in multiple journals. My practice is currently evenly divided between carotid endarterectomy and carotid stenting.
How do I determine if I could be a candidate for carotid stenting?
The biggest piece of advice I would give to patients who have carotid blockages is to approach a physician who is able to provide both of these treatment options. It is those physicians that will be able to give you the most unbiased recommendation as to which treatment is best for you, as there are specific subsets of patients that will benefit from one treatment more than the other.