What Is Carotid Stenosis?

eesh Babu of Vascular Associates ofendarectomy because we are removing the inner
Westchester discusses "What is Carotidlayers of the artery. Then we close the artery
Stenosis?", the treatments, who should beand usually the patient is observed overnight in
screened and future developments, such as newthe hospital and goes home the next day.
stenting techniques.What is the Prognosis for Carotid Stenting?
What is Carotid Stenosis?However, now as we speak there is now a new
Carotid arteries are the two major arteries thattreatment called stenting. As we use a stent in
provide the bulk of the blood to the brain. Theythe arteries in the heart, we are now stenting the
are the major arteries to the brain. Hardening ofcarotid arteries. We are one of the few centers
the arteries, atherosclerosis is a common disease.where it is being done. And there are 70 centers
Just like atherosclerosis can affect the heart itin the country that are testing whether stenting is
can affect the arteries to the brain. The arteriesbetter than the operation. The operation has been
to the brain are affected by plaque build-up. Sohighly successful and the risk of complications is
what happens is that the the arteries becomeonly 1 to 3 per cent. If we can do the stenting
narrow. If the artery is narrowed to a significantand it as good or superior than the operation than
degree -- generally more than 75% percent of itsobviously we will prefer stenting. I would say that
luminal area -- then there is a good chance thatwithin 2 or 3 years the results will be available to
the patient will have a stroke with 24 to 36see if the stenting is better. Certainly it is very
months. This is another area where detection isattractive option -- so you don't need so you
extremely important -- because once a strokedon't need to have an incision in the neck. We
happens the game is over, We cannot do toohave already done 200 of these cases with very
much to help the patient. This is one area wheregood results.
we need to get to the patient before he suffersWho Should Be Screened for Carotid Stenosis?
from a stroke. We can detect a problem byAnyone who has a risk factor for atherosclerosis
ultrasound -- its called duplex scanning. It is veryor hardening of the arteries. Anyone who has
simple. It takes 15 to 20 minutes to do the scan.cardiac disease. A patient with hypertension, a
It is non-invasive. It can be repeated over apatient with a history of smoking, a patient with
period of time. Once detected, indeed if it a tightdiabetes: they are all risk factors for stroke.
stenosis, meaning it is more than 75% blockageAnyone with these risk factors should be tested.
of the artery, we can actually remove the plaque.Otherwise anyone over 65 should have one
The operation is now so sophisticated that it canscreening, perhaps once a year, and have it done
be done now under local anesthesia, what we callso that the we know that the arteries are clean
a regional anesthesia. The patients go home in 24and we are all happy. Let's say there is a 50%
hours. It is a very successful operation. In fact itblock. Nothing needs to be done, but that kind of
is the most common vascular operation done inpatient needs to be followed up with a ultrasound,
the United States.a duplex sound, every 6 months, so that we
Can You Describe the Procedure?watch it carefully. And if his cholesterol is high, we
The procedure is essentially making an incision inwill control the cholesterol. If he is smoking we
the neck. If the patient is awake, he will be talkingask him to stop smoking. Good control of
during the operation. We expose the artery anddiabetes. All the risk modifications are important.
then isolate the artery -- then cut all theAnd then we follow him. And for some reason his
circulation to the brain during the procedure. Thenplaque build up keeps on growing and goes to a
we open the artery and literally remove the75% blockage, then we can at least pick it up and
plaque, like cleaning a pipe. This is calledtreat him.