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Preventing Stroke with a Carotid Artery Stent


Eric Cohen, M.D.

The carotid arteries in your neck supply the brain with blood. The carotid arteries travel up each side of the neck and branch into smaller vessels that supply blood to the brain. Blood flowing through the carotid arteries (carotid pulses) can be felt on each side of the neck next to the windpipe.

Unfortunately, the carotid arteries are a common location for hardening of the artery wall, called atherosclerosis, to occur. If the arteries become clogged, it can result in a stroke. Atherosclerosis is caused by a build up of plaque – cholesterol, white blood cells, calcium, and other substances – in the walls of the arteries. Over time, plaque narrows the artery, and the artery hardens.

Plaques are covered with a fibrous cap, which may rupture if some trigger causes a surge in blood pressure or causes the artery to constrict. A person may have a heart attack if a plaque breaks open, creating a blood clot that completely blocks blood flow through the artery. Or, plaque in the carotid arteries of the neck may break open and block blood flow to the brain, causing Transient Ischemic Attack (sometimes called "mini-stroke") or a stroke.

Transient Ischemic Attack (TIA) is a temporary interruption of the blood flow to an area of the brain. TIAs are a warning sign that a stroke may soon follow.

Fortunately in 2004, the U.S. Food and Drug Administration (FDA) approved the use of stents—tiny metal tubes—to prop open carotid arteries and reduce the risk of stroke. Carotid artery stenting is similar to coronary angioplasty, which is commonly used to open blocked arteries in the heart. Its use in carotid arteries is growing.

During this procedure, a tube (catheter) is inserted through a large artery—most often the femoral artery in the groin—and threaded through other arteries to the carotid artery. After the catheter reaches the narrowed portion of the carotid artery, a small balloon at the end of the tube is inflated for a short period of time.

The pressure from the inflated balloon presses the plaque against the wall of the artery to improve blood flow. A stent (a metal tube) is placed in the artery to keep the plaque from tearing open and to keep the artery from closing. New crush-resistant stents with filters to catch clots have been developed.
The procedure takes about one hour, and the patient usually is awake during the procedure and feels little pain. Usually, hospitalization is needed for about 24 hours after the procedure, to watch for complications.

Carotid artery stenting may prevent a transient ischemic attack (TIA) and stroke in people who have significant carotid hardening and narrowing (70 percent or more) of the carotid arteries.
A clot in an artery, a drop in blood pressure, or a change in heart rhythm or rate may all reduce blood flow to the brain and result in a TIA. Unlike a stroke, a TIA does not cause lasting symptoms, but is considered a warning sign of an impending stroke. Symptoms usually go away after 10 to 20 minutes. Symptoms of a TIA are similar to those of a stroke and may include:

• Vision problems
• Difficulty speaking, or unusual behavior and thought processes
• Difficulty understanding words
• Loss of consciousness
• Seizures
• Dizziness (vertigo) or trouble walking
• Weakness or numbness on one side of the body

To learn more about carotid stenting or to be screened for Atherosclerosis, contact the Heart & Vascular Center of Northern Arizona (HVCNA) at 877 928-WELL.

HVCNA is a partnership between Flagstaff Medical Center and Verde Valley Medical Center. It combines physician office practices with extensive hospital-based services including diagnostic and interventional cardiology procedures and open heart surgery. HVCNA offices are located in Flagstaff, Cottonwood, Camp Verde, Sedona and Winslow. For more information on the Heart & Vascular Center of Northern Arizona, visit NAHeartCare.com.

Dr. Eric Cohen, interventional cardiologist, is the medical director of Peripheral Vascular Intervention at the Heart & Vascular Center of Northern Arizona. Dr. Cohen specializes in vascular care and the treatment of peripheral arterial disease and limb salvage.

 



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