Carotid artery disease is a type of peripheral artery disease in which there is "artery hardening" (atherosclerosis) in the main arteries carrying oxygen-rich blood to the brain (the carotid arteries). People with this disease are at much higher risk of having an ischemic stroke, the most common type of stroke.
Carotid stenting is a catheter-based procedure in which a small, expandable, wire mesh tube (stent) is inserted into a diseased artery, serving as a scaffold to hold it open. This treatment provides an effective means of re-establishing blood flow through blocked carotid arteries. The development of drug-coated (drug eluting) stents has helped to reduce the rates of re-narrowing over the long-term.
The carotid artery is operated on to prevent strokes, which affect approximately 500,000 people per year in the United States. Strokes are the third leading cause of death each year in this country, with about 30 percent of all strokes occurring as a result of underlying carotid artery disease. The vast majority of disease in the carotid artery is very localized – making it amenable to surgery. Carotid artery surgery has been performed successfully for approximately 50 years.
The North American Symptomatic Carotid Endarterectomy trial, reported on in the New England Journal of Medicine in August 1991, stated that patients who had a carotid blockage (stenosis) of more than 70 percent and a transient ischemic attack (TIA) or nondisabling stroke did statistically better if they were operated on rather than being treated with medication. TIAs, all of which come on suddenly and do not last for a long period of time, include: amaurosis fugax, a “shade” that comes down over the eye, causing a brief loss of vision or part of the visual field; hemiparesis or hemisensory loss; weakness and/or numbness on one side of the body; or weakness and/or numbness of the face. Patients with TIAs or stroke-like symptoms should be immediately evaluated by their physician or go to the emergency room. Timely intervention can often prevent fatalities from occurring.
A number of large randomized trials have also looked at patients with asymptomatic carotid artery stenosis, the most important of which was reported on in the Journal of the American Medical Association in May 1995. This study looked at patients who had more than 60 percent carotid stenosis and were asymptomatic. Patients were randomized to surgical therapy or medical therapy, and over a five-year period, the risk of stroke was 11 percent in the medical group and 5.1 percent in the surgical one, representing an overall risk reduction of 53 percent. Surgery is most reasonable for patients with asymptomatic carotid artery disease when the cases involve both “good risk” patients who understand the risks and benefits of surgery and surgeons with excellent track records for the operation.
At Lahey Clinic we are very interested in stroke prevention, and particularly in carotid surgery. Our track record for elective carotid surgery includes both a mortality rate and risk of stroke of less than 1 percent, respectively. Additional risks include a 1 percent chance of postoperative bleeding and a 2 percent risk of postoperative cranial nerve dysfunction, which is typically partial and almost always resolves itself. Advantages of carotid surgery include:
For further information, please contact Lahey's Department of Vascular Surgery at 781-744-8577.