This article is concerning not only carotid disease but also the risk involved, such as stroke, and the procedure used to clear blockages of plaque from the carotid arteries that lead into the brain.

Carotid Artery Disease is similar to coronary artery disease in that both cause the development of plaque. Plaque is a buildup of fatty deposits, calcium, cholesterol, and fibrous material along the walls of the arteries. This leads to atherosclerosis which decreases the blood flow to the brain. Since oxygen is carried in the blood of the arteries this means the brain is not getting oxygen as well as not getting adequate blood flow. Without blood flow or oxygen the risk of stroke then increases exponentially until the person is living on borrowed time.

Three different types of stroke (CVA) can occur:

· Ischemic

· Transischemic Attack (TIA)

· Arterial Embolism.

An Ischemic stroke is caused from absolutely no blood flow to the brain at all.

A TIA is when a bit of the plaque material on the side of the vessel breaks off and gets into one of the tiny arteries inside the brain.

An Arterial Embolism is the process of clot formation and blocking an artery that is already narrowed from atherosclerosis.

Of course, that is just a piece of the puzzle. The stroke itself is still due to no oxygen, no blood flow, and no glucose to the brain cells. Without oxygen and glucose, the neurons in the brain cannot survive. If the stroke, regardless of which type it is, lasts over 3-6 hours the damage done to the person’s body is usually permanent.

The best question then is how can Coronary Artery disease (CAD) and stoke (CVA) be prevented in the first place? That answer is with diet, exercise (that has been cleared by your physician) and regular physical checkups as well as any medications for chronic disease processes.

When your physician performs the physical exam, he or she will listen to your heart and lungs, front, and back, all lobes of the lungs, several different heart sounds then you will notice the physician turn the bell of the stethoscope over and place the bell against your throat and ask you to hold your breath.

Your physician is listening to your caroid artery in your neck. Specifically for a bruit, which is a swooshing sound caused by a blockage of the carotid artery itself. That abnormal sound is called a bruit.

If the physician catches this early, there will probably be other tests ordered such as a carotid ultrasound. This uses sound waves to show any damage to the blood vessels. Sometimes the physician will also order a CT scan of the brain; this is done especially if a CVA is suspected.

Before the vascular surgeons were able to do a carotid stenting procedure the surgery in the 1980’s consisted of making a small incision in the neck, exposing the artery then manually removing the plaque from the artery. This is called an Endarectomy and it still being performed as well as the angioplasty, which was developed in the 1970’s before endarectomy. Angioplasty is the procedure whereby a long tube with a flattened balloon on the end is threaded through the catheter to the area of the plaque or a clot. When the affected area is reached, the balloon is opened and this flattens the plaque or clot against the wall of the vessel.

However, problems still occurred with both of these procedures and the mortality rate during the surgery itself was very high. For the persons who did well during and after the surgery the problem of restenosis (reoccurring blocked arteries) was also of high concern.

In the early to middle 1990’s angioplasty and stents came together and were begun as trial studies. It was discovered that the use of coated stents would help decrease the risk of restenosis and by 2004; the Federal Drug Administration (FDA) had cleared stents for use across the USA.

1.       Decreased risk of strokes or heart attacks

2.       Decreased risk of Restenosis

3.       Improvement in speed of thought processes as well as improved memory function

4.       Minimally invasive surgery (less of a scar) as well as decreased risk of postop infection

5.       Done under local anesthetic, not general

Dr Iris Grunnard is a consultant at Saarland University Clinic in Hamburg, Germany and she shared the results of her study that combined neuropsychological testing and perfusion imaging on 26 patients 24 hours prior to the procedure and again in 3 months after the procedure. These tests included cognitive speed and memory function as well as tests for dementia and depression. Magnetic Resonant Imaging (MRI) was also done before and after the stenting procedure. The tests showed an increase in cognitive speed and memory function. This was especially true in patients who already had a high degree of stenosis and decreased flow of the blood vessels to their brain.

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·         Risk of CVA, MI and death during and following the procedure

·         Restenosis of the vessel in the future

Who Would Be Considered A Good Candidate For The Stenting Procedure?

·         Patients who would have been considered high risk for endarectomy

·         In other words, patients with 60%or greater blockage of the carotid artery

·         Patients with history of TIA

·         Patent who have had Restenosis following a previous endarectomy

·         Patient who is asymptomatic but whose carotid artery has 80%or greater blockage

Who Would NOT Be Considered A Good Candidate For Stenting?

·         Patients with a life expectancy of less than two years

·         Patients with heart problems such as irregular heartbeats

·         Patients with CVA and or bleeding in the rain within the last two months

Patients with a 100% blockage of the carotid artery

· Hypertensive episode (could lead to CVA)

· Allergic reaction to the contrast dye (could lead to anaphylactic shock)

· Narrowing of the artery to the extent the stent cannot be advanced into position

· Advanced amount of plaque along the sides of the vessel walls near the area where the stent needs to be placed

· Death, especially true for patients who are over the age of 80 years

· Loss of feeling on one or both sides of the patients body

· Headaches and visual changes

The carotid stenting procedure may be done under general anesthesia but most vascular surgeons prefer the use of local anesthetic so that brain function can be tested closely during the procedure. A contrast dye is injected by way of an intravenous fluid so that the specific artery can be located. When the vessel with the plaque buildup is coated then the angioplasty portion of the procedure is done.

 Live x-ray (real time x-rays) is used and this allows the vascular surgeon to see exactly where to guide the catheter. An embolic protection device is also inside the catheter to catch any clots or debris that may break off the walls of the vessel as the catheter is being threaded. When the affected area is reached, the balloon is inflated and deflated to flatten the plaque then both the balloon and the embolic protection device are withdrawn from the catheter.

The mesh stent is then threaded through the catheter; it goes in flat, just like the angioplasty balloon. When it reaches the affected area the vascular surgeon opens, the stent fits it perfectly at the place where the artery used to be crowded with plaque.

The stents are made of stainless steel or a metal alloy and are coated to make them slick. This helps prevent restenosis of the vessel. However, the patient will always have to take a blood thinner such as Coumadin (warfarin) and or aspirin to prevent blood clots. The entire procedure can take up to two hours.

Sometimes the patient is allowed to return home the same day but most surgeons prefer to have their patients monitored for at least 23 hours following this procedure.

·         Hemorrhage (excessive bleeding usually at the site of the catheter insertion but also can occur in the brain)

·         Pulmonary Embolism (Blood clot in the lungs)

·         Thrombosis (Blood clot in the legs)

·         Hypotensive or Hypertensive episode (high or low blood pressure issues)

·         Embolic Stroke

·         Cranial Nerve Injury (may or may not be permanent, usually only occurs on one side and resolves itself)

NOTIFY YOUR PHYSICIAN OF THE FOLLOWING:

·         Chest pain

·         Tightness of the chest or jaw pain

·         Unrelieved anxiety and shortness of breath

·         Painful respirations

·         Excessive bleeding or bruising

·         Gastric distress, nausea, vomiting

·         Pain when walking especially in calves

·         Swelling of one or both legs

·         Difficulty breathing or shallow respirations

·         Changes of mental status, drooping of one side of the face, drooling, difficulty speaking or swallowing, falls or inability to walk

·         You now have new plumbing; all your pipes have been flushed and your brain is getting fantastic blood flow, oxygen, and glucose to keep your brain healthy!

·         Since you cannot take Rid x on a monthly basis, this is what you need to do to keep it that way!

·         Follow your physician’s orders on medications, diet, and exercise!

·         See your physician regularly. Get all your lab work done as scheduled.

·         Set a walking goal and be consistent. It does not have to be far, it does not have to be outside, and you do not need to pay for a gym. All you have to do is walk at least half an hour every day. You will need to build up to that daily walk, especially if you have been sitting on the sofa for a while.

·         Decrease the amount of food you eat at every meal. Try eating small, frequent meals. Avoid red meat. Increase chicken and fish. Avoid fried foods. Bake or broil all meats. Increase fresh fruits and vegetables.

·         If on warfarin to prevent clots, limit or cease your alcohol consumption. Alcohol thins the blood. Avoid leafy green vegetables as they contain vitamin K which thickens the blood. Leafy greens and alcohol will skew the lab results. If that happens you will have to go to the lab more often, the results will not be easily stabilized. Whenever the results of your Coumadin (warfarin) test are too high or too low this increases your risk of complications such as clots and bleeding.

This has been a lot of information to cover but it is imperative that it be understood what this procedure is for and what it entails. More than that, this information can increase everyone’s awareness that this does NOT have to happen in YOUR FUTURE at all!

Start NOW to change your lifestyle!

Do NOT wait until your start getting headaches or you wake one morning and cannot hold your toothbrush or walk!

Change just one small thing a month or even a quarter and keep changing until every aspect of your health has been improved.

No one can stop his or her body from aging, changing or deteriorating but no one has to help it rush down the path of destruction either!