Carotid Artery Stents

A few weeks ago I underwent a procedure known as carotid angioplasty with stenting. In this post, I would like to share my decision processes and experiences relative to that procedure. But first, a little background information.

"Hardening of the arteries," aka atherosclerosis, is the causative factor behind hundreds of thousands of deaths or permanent physical disability in the United States alone. If this condition involves the carotid arteries, the affected individual is said to have "carotid atherosclerosis" and is at a higher risk of stroke than the overall population. Although medical management of carotid atherosclerosis,which includes low-dose aspirin and a drug known as Plavix along with a lipid-lowering medication of the statin family can be effective, if an individual develops symptoms of decreased blood flow to the brain (such as a Transient Ischemic Attack, or "TIA"), their physician may discuss the potential benefits and risks of a surgical procedure known as a carotid endarterectomy.

Although carotid endarterectomy is the procedure of choice for removing plaque from the carotid arteries, it is far less effective in those cases where a recurrence takes place at the previous operative site. Since I had undergone a left carotid endarterectomy in 2003, I fell into the latter category when I had two TIA-like episodes in late spring and early summer of this year. After reporting these events to my neurologist, and after the usual referrals and appointment-settings, I met Dr. Neil Shadoff, an interventional cardiologist with the Presbyterian Heart Group in Albuquerque. After reviewing my medical records and physical exam, Dr. Shadoff addressed the issues at hand.

Since 2003, I had developed not one but two "high grade" (meaning in the 80 to 90% range) obstructions to blood flow despite being on appropriate medical management. My choices were therefore quite simple: either continue with medical therapy (which, obviously, had not worked and carried a 3 to 5% risk of death or disability), re-operation (with about a 3 to 5% risk of death or disability), or the relatively new procedure of carotid stenting (which, despite my medical history, carried only 1 to 3% risk of death or some other form of serious disability). After briefly considering the risks of each available option, I chose Door #3 and was soon given a tee time of 8:30 AM on October 26^th.

The carotid stenting procedure itself is only mildly uncomfortable, far less so that having a tooth pulled, with most of this discomfort being related to the use of local anesthesia and the pressure sensations accompanying the introduction of specially-designed catheters via the groin arteries. I did experience some "flushing" and "warmth" when x-ray dye was injected to precisely define the location and extent of the targeted obstructions. Although I did not experience it, some patients report being aware of "pressure" or "fullness" when the stents themselves are placed. Given some of my recent experiences with vascular surgery, carotid stenting was a walk in the park and I the next day I .was back home in time to watch the noon news

I offer my experience with this procedure in partial rebuttal to the many health-oriented web sites that are critical of carotid angioplasty with stenting. As an example, the Carotid Angioplasty and Stenting page at the Massachusetts General Hospital web site holds that carotid stenting is riskier than endarterectomy. However, this site does not cite medical literature published after 1998, nor does this site appear to have been updated since that time. Unfortunately, Web sites containing out-of-date references are very common. I would thus advise users of any medical information sites to closely check the publication dates of any cited references.

In conclusion, carotid stenting is now considered to be the treatment of choice in a select subgroup of those patients with carotid artery disease who 1) have a chronic, coexisting, cardiovascular condition which increases the overall risks of surgical complications, or 2) have had a recurrence of a previous surgically-repaired carotid artery stenosis. Although I cannot, of course, guarantee that others will have a similar experience, I would not hesitate in recommending this procedure to others finding themselves in a similar situation..

More information on carotid angioplasty and carotid endarterectomy can be found at the following web pages.

Carotid Endarterectomy . Encyclopedia of Surgery, 2010. (http://www.surgeryencyclopedia.com/). Accessed December 4, 2010.

Carotid Endarterectomy for TIA and Stroke , undated. WebMD (http://www.webmd.com/stroke/). Accessed December 1, 2020.

Carotid Angiography and Stenting, undated. Cleveland (OH) Clinic. (http://my.clevelandclinic.org/heart/services/) Accessed December 1, 2010.