A quarter of the people who have strokes in this country also have carotid artery disease. They are arteries in the neck that carry blood to the brain. When plague builds up, blood flow is restricted which can lead to a stroke.
We talked to two experts in the field of treating carotid artery stenosis, one of them lives and works in Sioux Falls and the other practices in Chicago at Northwestern Memorial Hospital. He was in Sioux Falls on May 2nd for the North Central Heart Vascular Symposium.
Dr. J. Michael Bacharach and his team at the Avera Heart Hospital of South Dakota are performing a carotid artery stenting procedure in the cath lab on a man his 70's who is awake and was a smoker until a couple of months ago. We saw the angiogram taken a month before surgery. The white area is where the blockage is and is at ear level on the right side. A month ago he had a stent put in on the left side.
Through an incision in the groin, they are threading a wire with a balloon and stent up to the exact spot where the blockage is bad. The expanded stent acts as scaffolding to force open the walls of the artery and hold it in place. North Central Heart is currently studying, through clinical research trials, a protective filter that is now being used during this procedure.
Dr. Bacharach says, " With angioplasty and stent we use protection device, a little umbrella-like filter that goes above the area we are going to repair and in turn collects any debris or material that may be loosened or flick off during the procedure. It's just another protection against having a stroke during the procedure. One the angioplasty is in place we remove that filter.
Dr. Jon Matsumura from Northwestern Memorial Hospital says, "Carotid stenting is a technology that's been under development for many years, but we are just learning now to use it and how to select patients out that are ideal candidates for stenting."
Dr. Bacharach is known for having a finesse for this. One nurse told me, if the blockage can be reached with a wire, Dr. Bacharach can fix it. No doubt the patient on the table and hundreds of others like him are grateful for that.
Both doctors say the key is finding the right patients for stenting. Typically the ones at high risk are better candidates for this because this procedure is less invasive than surgery where they make an incision in the neck to remove the fatty buildup.