– A new study has announced that different procedures to prevent stroke have different long-term results. The Swedish study compared carotid artery stenting (CAS) and carotid artery endarterectomy (CAE) effectiveness, tracking patients for nearly five years.
Dr. Eugene Tanquilut, fellowship trained vascular and endovascular surgeon, says it’s important that patients know those results before committing to a carotid artery disease procedure.
“The carotid arteries are two large blood vessels, about the size of drinking straws, that run up each side of the neck,” said Tanquilut. “They are the main arteries carrying oxygenated blood to the brain, which controls cognitive functioning such as thinking, learning, problem solving, speech and sensory and motor functions. It’s also the part of the brain where your “personality” resides.”
Carotid artery disease (CAD) is also known as carotid artery stenosis or narrowing. CAD is typically caused by plaque, which is a buildup of cholesterol and calcium within the arteries, narrowing the area through which oxygenated blood can travel.
“Because the carotid arteries supply blood to cognitive functioning, a blockage, called an occlusion, or clot within the arteries will cause stroke and compromise the ability to speak, walk, and simply perform the activities of daily living,” said Tanquilut. “Avoiding carotid artery disease, keeping these arteries healthy and functioning, is vital to preventing a life-changing stroke.”
Carotid artery stenting, Tanquilut explained, is also referred to as carotid angioplasty and stenting. “A stent is a hollow mesh tube, that is collapsed when we insert it. We place the stent inside a catheter and then insert that catheter into a large artery – usually the femoral artery found in the groin. Using dye and imaging technology, the catheter is guided up to the narrowest part of the carotid artery. We move a balloon into the stent, inflate the balloon, which expands the stent. This compresses the plaque against the blood vessel’s wall, opening the artery and increasing blood flow.”
A CAS might be a good choice when arteries are more than 50% narrowed, when the patient has already had a stroke or TIA (transient ischemic attack, considered a warning sign of future stroke), or has had radiation or multiple surgeries to the neck and has abnormal anatomy.
A carotid endarterectomy (CAE) is considered the gold standard for carotid intervention. It is a more invasive procedure which may be indicated when carotid arteries are more than 50% blocked with stroke or TIA occurrence or when more than 80% of the arteries are blocked with no stroke or TIA occurrence.
Tanquilut explained that a CAE is a completely different procedure. CAS is an endovascular procedure which means it is minimally invasive surgery, with one very small incision in the groin.
CAE is a vascular procedure, more like traditional surgery. “Our incision will be in the front of your neck,” he said. “We open the carotid artery and actually remove the plaque; we don’t just compress it. We then repair the artery by using a natural graft, a piece of vein from elsewhere in the body, or a woven patch. We then close the incision.”
The Swedish study was conducted because of a lack of real evidence about any differences in long-term results for CAS and CAE. Researchers followed 1,157 patients, 409 of whom had the stenting procedure and 748 of whom had the endarterectomy. Most of the patients were men, whose average age was 70. They were matched as closely as possible for sex, age, procedure date and symptoms.
The study found that 25.7% of CA Stenting patients had a stroke in the years following their procedure, versus 18.6% of CA Endarterectomy patients. These were long-term results; outcomes in the first 30 days showed no difference between the procedures.
“While a CAE is a more invasive procedure, the hospital stay is the same as carotid stenting, patients almost always go home the next day and CAE has a better long-term result,” said Tanquilut. “CAS patients may see restenosis, when the artery re-narrows soon after the procedure. Blood clots may form on the stent itself.”
For patients struggling to decide what’s best for their health today and for the long-term, it’s vital to consult a fully qualified endovascular and vascular surgeon. “A surgeon who’s trained in both carotid endarterectomy and carotid stenting is far and away the best choice for patients with carotid artery disease,” says Tanquilut. “By thoroughly understanding both techniques and fully examining the patient’s disease and overall health, a solid decision – one that focuses only on the patient’s best interests – can be made.”
Tanquilut is with Vascular Specialists in New Lenox and Olympia Fields. He is a graduate of Carl Sandburg High School in Orland Park and received his fellowship training at the Cleveland Clinic.
“While CAS and CAE can vastly improve the condition of carotid artery disease, the patient’s lifestyle must change,” says Tanquilut. “Patients will take an antiplatelet medication, must stop smoking and will need to be physically active and eat a healthier diet. If a patient is overweight, weight loss is vital.”
“Without a strong commitment to their health, the patient will see that the disease will undo all the improvements the surgery effected. Once you have carotid artery disease, you can’t get rid of it – you have to take care of yourself every day. There is no cure for CAD.”