Summer 2005 Issue

Stent System Is Effective And Less Invasive
In Preventing Stroke
Our Practice To Become Regional Training Site For Carotid Artery Stenting

After receiving FDA approval last year, the use of stenting to clear blockages in the carotid arteries is on the rise. These stents are designed for use in patients who have experienced symptoms of a stroke or whose carotid artery has significant blockage, and who are not good candidates for carotid endarterectomy -- the traditional surgical option.

VIDEO - click here to view an animation of the stenting procedure.
Carolina Neurosurgery & Spine Associates has used stents to treat carotid artery disease for the past five years, and is the only neurosurgery group in the region performing this procedure. The practice is also a leader in carotid artery clinical trials, with participation in the Cabernet, Capture, Cases and Crest studies.

“These trials provide access to the newest equipment,” said Carolina Neurosurgery & Spine Associates neuroendovascular surgeon Joe Bernard, M.D., “including distal protection devices that can improve the overall safety of the procedure.”

This fall, Carolina Neurosurgery & Spine Associates and The Sanger Clinic will become a regional training resource for carotid artery stenting procedures.

The Interventional Approach
Carotid artery stenting is a minimally invasive procedure to prevent strokes in patients who are at high-risk for surgery. The procedure uses a combination of balloon angioplasty and a stent to unblock and reopen the carotid artery.

Under local anesthesia, a catheter is inserted through a small incision in the patient’s groin and into the femoral artery. The catheter is then guided to the site of the blockage. An embolic protection system is first delivered to the artery and opened against the walls of the artery (Figure 1). This device has a filter designed to catch any debris that may loosen during the stenting procedure and prevent it from traveling to the brain, where it could trigger a stroke or other complications.

A balloon catheter is then navigated to the site and expanded to press plaque against the artery walls. Another catheter is then used to deliver a stent to the blockage site where it is placed to keep the artery open (Figure 2). Any plaque that is dislodged during the procedure is captured by the embolic protection system, which is then collapsed and removed.

“Using the stent, patients are usually home the next day and back to work in about three days,” said Dr. Bernard.

Carotid Revascularization
For patients with carotid artery disease who are not high risk, the current standard treatment for stroke prevention is carotid endarterectomy. While the patient is under general anesthesia, the surgeon makes an incision in the neck and removes the plaque and diseased portions from the artery Then, the artery is sewn back together to allow blood flow to the brain. Approximately 200,000 carotid endarterectomies are performed each year in the United States.

“Carotid endarterectomy is a proven procedure,” said Dr. Bernard. “Now, treating high-risk patients with stents is approaching the same level of safety found in performing carotid endarterectomy on healthier patients. Our practice is able to offer either option depending on the condition of the patient.”

Carolina Neurosurgery & Spine Associates performs both carotid stenting and carotid endarterectomy at Carolinas Medical Center in Charlotte, NorthEast Medical Center in Concord, and Piedmont Medical Center in Rock Hill.

“We’re honored to play a vital role in making this new procedure available to the region,” said Dr. Bernard. “Our practice will train others in carotid stenting and will continue to participate in research that will further refine the process and potentially make this procedure the standard for treating carotid artery blockage.”
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