Lifewatch: Carotid Angioplasty and Stenting

Reported by Claire Hosmann - email
Posted by Debra Worley - email

(WECT) - Carotid Angioplasty and Stenting is a growing procedure to clear out arteries that feed the brain, but it can also be dangerous.

Now, there's a new tool that's protecting patients from the threat of strokes and death.

Charlie Akers' radio has been his link to the rest of the world since he was a kid.

The 58-year-old has his share of stories to tell - he survived a battle with cancer in his tonsils, then he learned he had carotid artery disease which means the main arteries in his neck were clogged.

In the standard procedure to clear the arteries, a catheter is threaded through the groin into the artery.  A balloon expands and a stent is left in place.

"One of the concerns, of course, is that when you blow up either a balloon or put a stent in the carotid artery, that particles can break off and go on up into your brain," said Dr. Alan L. Lumsden.

If particles block blood vessels, it can cause stroke or death.  Instead, Dr. Lumsden performed an experimental surgery on Charlie.

Two balloons are placed in carotid arteries.  A device reverses blood flow, blood moves away from the brain to a filter outside of the body where particles are collected.

"You can back flush blood out of the head to wash out anything that you have knocked off," said Dr. Lumsden.

A stent is placed in the artery and blood flow returns to normal.  Charlie was in the hospital for less than two days.

About 40 sites across the nation are testing the new procedure, which Dr. Lumsden says maybe be available in a couple of years.

Right now, it is only approved in Europe.

For more information, please contact:
Methodist DeBakey Heart Center
Erin Fairchild, Public Relations Manager

BACKGROUND: The carotid arteries lie in the neck and supply the brain with oxygenated blood. Carotid artery disease occurs when these arteries become narrowed or blocked. The problem occurs more often with age. According to the Society for Vascular Surgery, only one percent of adults between ages 50 and 59 develop the disease while 10 percent of adults age 80 to 89 have the condition.

The inside of healthy carotid arteries are smooth, allowing blood to flow freely. With age, however, plaque can build up on the walls in a process called arteriosclerosis. The plague is a sticky substance consisting of cholesterol, calcium and fibrous tissue. The condition is classified as carotid artery disease if enough plaque builds up to where blood flow is obstructed. If left untreated, it can lead to a stroke. After confirming a diagnosis with an ultrasound or other diagnostic test, a patient is treated with either surgery or a less invasive technique involving angioplasty and stenting.

TREATMENT: The surgery, called carotid endartectomy, is usually performed in more severe cases. During the procedure, a vascular surgeon makes an incision in the neck and removes the plaque from the lining of the arteries. Some patients may be able to leave the hospital that day or the day after the procedure.

A newer minimally invasive technique involves inserting a catheter into the carotid artery. "There has really been an explosion in carotid stenting over the past four to five years," Alan L. Lumsden, M.D., a cardiovascular surgeon at the Methodist DeBakey Heart and Vascular Center in Houston, Texas, told Ivanhoe. An angiogram reveals to the surgeon the location of the blocked artery. Dye is injected into the artery through the catheter and shows up on an X-ray. Another catheter is inserted, carrying a tiny balloon. When the balloon is inside the blockage, it is inflated and deflated, flattening the plaque against the artery wall. A small stent made of a metal-mesh material is placed inside the circumference of the artery to hold it open. The minimally invasive procedure is suggested for patients considered high risk for the surgical procedure.

A problem with the procedure, however, is when the balloon is inflated and the stent is put in place, pieces of plaque can break off, travel up to the brain and cause a stroke. The new GORE Neuro Protection System seeks to reduce the incidence of stroke by catching free flowing particles. The system is currently being evaluated in the Embolic Protection with flow Reversal (EMPiRE) clinical trial. The system works by reversing blood flow in the blocked arteries so particles that break off during the procedure flow away from the brain to a filter system located outside the body. To reverse blood flow, a shunt, or balloon, is placed between the carotid artery and femoral vein. The surgeon uses transcranial Doppler monitoring to assess the flow of blood. "It allows us to use ultrasound to look specifically at what is going on with the blood supply while we are doing it, so we use that as an additional level of monitoring to make sure there is adequate blood supply to the patient's brain," Dr. Lumsden explained. After the stent is put in place, the balloon is deflated and blood flow returns to normal.

Dr. Lumsden says the device is a bit more difficult for the vascular surgeon to operate. "It takes a little bit of getting used to," he said. The system is fully approved in Europe. The clinical trial currently underway in the United States is evaluating its safety and efficacy. Dr. Lumsden says it may be two years before the GORE Neuro Protection System is approved in the U.S.