What is Carotid Stenosis?



Carotid arteries are the two major arteries that provide the bulk of the blood to the brain. They are the major arteries to the brain. Hardening of the arteries, atherosclerosis is a common disease. Just like atherosclerosis can affect the heart it can affect the arteries to the brain. The arteries to the brain are affected by plaque build-up. So what happens is that the the arteries become narrow. If the artery is narrowed to a significant degree -- generally more than 75% percent of its luminal area -- then there is a good chance that the patient will have a stroke with 24 to 36 months. This is another area where detection is extremely important -- because once a stroke happens the game is over, We cannot do too much to help the patient. This is one area where we need to get to the patient before he suffers from a stroke. We can detect a problem by ultrasound -- its called duplex scanning. It is very simple. It takes 15 to 20 minutes to do the scan. It is non-invasive. It can be repeated over a period of time. Once detected, indeed if it a tight stenosis, meaning it is more than 75% blockage of the artery, we can actually remove the plaque. The operation is now so sophisticated that it can be done now under local anesthesia, what we call a regional anesthesia. The patients go home in 24 hours. It is a very successful operation. In fact it is the most common vascular operation done in the United States.

Can You Describe the Procedure?

The procedure is essentially making an incision in the neck. If the patient is awake, he will be talking during the operation. We expose the artery and then isolate the artery -- then cut all the circulation to the brain during the procedure. Then we open the artery and literally remove the plaque, like cleaning a pipe. This is called endarectomy because we are removing the inner layers of the artery. Then we close the artery and usually the patient is observed overnight in the hospital and goes home the next day.

What is the Prognosis for Carotid Stenting?

However, now as we speak there is now a new treatment called stenting. As we use a stent in the arteries in the heart, we are now stenting the carotid arteries. We are one of the few centers where it is being done. And there are 70 centers in the country that are testing whether stenting is better than the operation. The operation has been highly successful and the risk of complications is only 1 to 3 per cent. If we can do the stenting and it as good or superior than the operation than obviously we will prefer stenting. I would say that within 2 or 3 years the results will be available to see if the stenting is better. Certainly it is very attractive option -- so you don't need so you don't need to have an incision in the neck. We have already done 200 of these cases with very good results.

Who Should Be Screened for Carotid Stenosis?

Anyone who has a risk factor for atherosclerosis or hardening of the arteries. Anyone who has cardiac disease. A patient with hypertension, a patient with a history of smoking, a patient with diabetes: they are all risk factors for stroke. Anyone with these risk factors should be tested. Otherwise anyone over 65 should have one screening, perhaps once a year, and have it done so that the we know that the arteries are clean and we are all happy. Let's say there is a 50% block. Nothing needs to be done, but that kind of patient needs to be followed up with a ultrasound, a duplex sound, every 6 months, so that we watch it carefully. And if his cholesterol is high, we will control the cholesterol. If he is smoking we ask him to stop smoking. Good control of diabetes. All the risk modifications are important. And then we follow him. And for some reason his plaque build up keeps on growing and goes to a 75% blockage, then we can at least pick it up and treat him.