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Stenting An Option for Carotid Artery Blockage

NEW YORK May 13, 2004

Removing blockage in the main arteries of the neck that supply oxygen-rich blood to the brain can be a risky business for the sickest patients, but new procedures using stents, small spring-like structures that actually help hold arteries open, reduces the risk of complications and death, according to Kenneth Ouriel, M.D., Professor of Surgery, Chair, Division of Surgery, Cleveland Clinic Foundation, in Cleveland, Ohio.

"Patients with medical conditions such as a heart disease or those who have had radiation therapy to the neck--these patients do not do as well as others during routine carotid surgery--these patients face greater risks such as heart attack, greater risks for complications and even death," Dr. Ouriel said. He spoke today at an American Medical Association media briefing an cardiology in New York City.

The carotid arteries in the neck provide the main supply lines of blood to the brain. Smoking, diabetes, high blood pressure and cholesterol levels, and being overweight can cause atherosclerosis or hardening of the arteries, leading to build up of plaque in the artery walls. Such carotid artery disease is a major cause of stroke, heart attacks and other cardiovascular disease. Traditionally, surgeons have treated patients with carotid endarterectomy, making an incision in the neck to access the carotid artery and cleaning out the plaque along with the entire lining of the arterial wall.

"We've been doing carotid endarterectomy for 50 years with really great results," Dr. Ouriel said. "However, for some patients, this may not be the best option." He explained that inserting stents may be a better option for high-risk patients.

"The stent is inserted through a catheter in the leg and worked up into the carotid artery," Dr. Ouriel explained. "We're also using emboli protection above the stent, a kind of filter to catch small particles that become detached and travel to the brain during the procedure. The new procedure is less invasive for patients and has the same or a higher success rate than carotid endarterectomy."

Stenting has been used to treat blocked heart arteries, but the application of stents to unblocking carotid arteries is new. The FDA has not yet approved the procedure for treating carotid blockage, but an expert panel has authorized use of stenting for carotid blockage in continuing clinical trials. "Some of the panelists voted against it, but I believe this new procedure will save the lives of the very sickest patients," Dr. Ouriel said.

He noted that in a recent study of 310 patient with carotid disease in which half received stenting and half carotid endarterectomy, stenting had results as good as or better than the older procedure in terms of stroke, heart attack and death. "While stenting may be more expensive in terms of total cost to the hospital, there appear to be significant clinical benefits for the patient,"Dr. Ouriel noted.

Carotid artery disease may be diagnosed as an asymptomatic narrowing, and can be detected on routine medical check up. Alternatively, the narrowing may present symptomatically, with a ministroke (often called a transient ischemic attack or TIA) or, occasionally, with a major stroke. Physicians can diagnose it by listening to sounds in the neck. More frequently, however, the disease is picked up with imaging tests.

Treatment, aside from surgery, includes making lifestyle changes. Patients may also be prescribed drugs such as aspirin to interfere-with blood platelets or cholesterol-lowering agents to reduce the formation of arterial plaque formation. To date, surgery has been the best option for many patients but for the sickest ones, it can be risky.

“If stenting can achieve the same results as endarterectomy, we could have, lower post-operative . complications such as heart attack and death in our most at-risk patients," Dr.. Ouriel concluded.

Media Advisory: To contact Kenneth Ouriel, M.D., call Alicia Sokol at 216-445-9661 or email: sokola@ccf.

Editor's Note; Dr. Ouriel has no financial interests, arrangements, nor affiliations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation to disclose. He has received an honorarium from the American Medical Association to speak at today's briefing.