Carotid stenting – prevention of stroke
Along with heart attack and cancer , stroke is one of the most common causes of death and is the most common reason for needing care in adulthood. In Germany, around 270,000 people suffer a stroke every year, not counting the unnoticed, “silent” cerebral infarctions. The consequences of a stroke – from weakness in arms or legs to paralysis and death – are well known. But how does this happen?
Narrowing of the carotid artery
Around 18 percent of strokes (30,000) are due to a narrowing of the carotid artery. The carotid arteries run up into the head on either side of the neck and supply blood to the brain. They are called carotis, which means “sleep-bringing” artery, because a disruption in blood flow robs people of consciousness. A narrowing or even an occlusion of the carotid arteries, the so-called carotid stenosis, is correspondingly dangerous.
Causes of Carotid Stenosis
The main cause of carotid stenosis is hardening of the arteries (arteriosclerosis). It usually occurs in people over the age of 60. As with all vascular diseases, the risk factors include high blood pressure, too much blood fat, diabetes , smoking, lack of exercise and obesity .
The gradual deposition of fat on the vessel walls leads to narrowing of the carotid artery. The blood no longer flows freely to the brain – the result is symptoms such as circulatory, vision and speech disorders, numbness and tingling, paralysis, headaches and dizziness . Over time, plaques ( clots ) form on the vessel walls.
It becomes really dangerous when these detach and are carried into the brain with the bloodstream: The plaques can block smaller arteries and thus lead to neurological damage up to stroke and death. In Germany, around one million people live with more than 50 percent carotid stenosis.
How does the doctor determine if there is carotid stenosis?
Quite simply by listening with a stethoscope or using, for example, ultrasound, angiography or computed tomography . Some calcification is part of the natural aging process. In these cases, the doctor only prescribes a drug that improves blood flow and prevents blood clots from forming.
If a stroke has already occurred or if there is a high-grade carotid stenosis, an operation has usually been performed (carotid TEA). The surgeon opens the carotid artery, cuts it off from the bloodstream, removes the calcification, cleans the vessel and sews it back together. In some cases, a “patch” made from a piece of vein or plastic material is sewn in (grafting).
Innovative treatment option
Selected patients can now be spared the operation: their carotid arteries are expanded by carotid stenting. This minimally invasive treatment can usually be performed under local anesthesia and does not require an incision in the neck. It puts less strain on the vessel and the surrounding neck nerves, is not associated with surgical trauma and can also reach vessels that are not accessible to surgical intervention (e.g. near the base of the skull).
How does carotid stenting work?
The principle is simple: expand, secure, support. From the groin, the necessary instruments are pushed into the carotid artery using a catheter. A balloon widens the constriction. Plaques can detach in the process – if they reach the brain, there is an acute risk of a stroke!
To avoid this, the doctor often introduces an additional safety system: a small umbrella unfolds in the vessel and catches the loose parts. A stent (mesh-like wire) is then inserted to support the vessel wall. The doctor uses a small amount of contrast medium to check whether the closure has been opened successfully.
If the findings are unremarkable, the balloon, catheter and the folded umbrella are pulled out together with the dangerous loose plaques and pieces of tissue. Only the stent remains in the body so that the carotid artery does not narrow again. Over time, the arterial wall tissue grows around the stent, giving the artery additional strength. With all the preparations and the check-up, the procedure takes around 45 minutes.
benefits for patients
- No surgical procedure, far less traumatic
- Local anesthesia instead of general anesthesia
- No surgical scar on the neck
- Objectively and subjectively shorter recovery times, which means the patient can be discharged home more quickly.
Important study results
A recent study (SAPPHIRE) confirms the positive results of minimally invasive carotid stenting in patients with a significantly increased risk of surgery. This is good news for these patients with, for example, severe heart or lung diseases. The results obtained with carotid stenting are just as good as with the operation, which is particularly risky for them.
As long as no other study results are available, all other patients will continue to be advised to have an endarterectomy or, in milder cases, drug therapy.
Availability of carotid stenting
Carotid stenting is offered nationwide in Germany. Not only university clinics can perform the procedure, but any radiological, vascular surgery and cardiological practice, provided that the staff there has the appropriate training. Patients who are wondering where they should be treated best can use the number of interventions as an assessment criterion: the more experience and routine a medical team has gained, the greater the success of the treatment.
Conclusion
Carotid stenting is another treatment option for narrowed carotid arteries. More and more doctors and patients are consciously opting for this form of stroke prophylaxis. The success and complication rates as well as long-term results of stent-supported carotid angioplasty are currently being compared with the surgical procedure in further prospective randomized studies. When deciding which form of treatment is right for you, you should carefully weigh the pros and cons with your doctor.
