Carotid stenosis increases the risk of stroke

Newswise – They call heart disease a silent killer, and it doesn’t get much quieter than carotid stenosis.

Two large arteries on both sides of the neck carry oxygen-rich blood to the brain. When they begin to close due to a buildup of plaque in the blood, a patient may not notice anything. But when the flow stops or part of the plaque moves to the brain, the result is a stroke.

Until about seven years ago, people with carotid stenosis had two options. Medicines to lower cholesterol and fatty deposits in the blood might control the closing. Or, in cases where the artery is blocked 80% or more, surgery is recommended. A third, recently developed, minimally invasive option – transcarotid artery revascularization (TCAR) – may help some patients.

For symptomatic people, surgery is usually a no-brainer.

“Symptomatic means they had a stroke or mini-stroke,” said Dr. Christopher Werter, a vascular surgeon at Penn State Health St. Joseph Medical Center. “These patients are almost universally in need of help.”

This operation is not without risk. This involves opening up the artery and clearing away plaque, and patients may be at risk of a stroke during surgery. In fact, the risk of surgery, coupled with the relatively meager outcomes – almost as many patients who have had surgery experience strokes as those who have not – have led some cardiovascular surgeons to question whether the practice is justified in asymptomatic patients. at all, said Werter.

TCAR, however, does not involve surgery. The procedure protects the brain by redirecting blood from the carotid artery to the femoral artery in the thigh, allowing doctors to insert stents into the artery in the neck. On April 27, Werter performed the second TCAR procedure from St. Joseph Medical Center. It took about an hour.

The procedure is not for everyone. Currently, only patients who are not healthy enough to undergo surgery or who are otherwise prevented from doing so may be candidates for TCAR. As the numbers and statistics continue to show its effectiveness, that could change.

“People should be sure of all the options,” Werter said. “Make sure they are informed of the alternatives and options available, whether it is medication or surgery. Make sure you’re in a place where they can process something in multiple ways. So when you have options, you can choose what you think is the right thing.

See the attached graphic for some facts about the TCAR procedure at St. Joseph Medical Center.

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