Carotid artery stenting nice option against TIAs

Both my parents had skinny little scars over their carotid arteries — the arteries that supply blood to the brain. The carotid arteries are right there on the side of your neck. They’re a great place to take your pulse. They’re easy to get to when you’re doing your aerobics and need to see if you’ve made it to your target heart rate.

My parents had carotid endarterectomies. Their surgeons opened up those arteries and scraped out the atherosclerotic plaque that had accumulated there after years of barbequed steaks and whole milk. My mom was having transient ischemic attacks (TIAs) — little mini strokes that are common when pieces of plaque break off and travel to the brain. And having all that plaque put both my parents at risk for having a full-blown stroke, so getting the arteries scraped out was a good idea.

But as is true of so much in medicine these days, there’s now an easier way to get the job done, one that doesn’t require general anesthesia, a visit to the operating room or a stay in the hospital. It’s called carotid artery stenting. Doctors, working in the radiology suite instead of the surgery suite, thread a tiny catheter through a vein in the leg and guide it up to the carotid artery. Once there they inflate a tiny balloon at the end of the catheter and press the plaque into the artery wall. Then they thread in a mesh scaffold (the stent) to keep the artery open and keep the blood flowing to the brain.

But carotid stenting is not without its problems. In the process of pressing that plaque into the artery wall, tiny pieces can break off and float up into the brain causing problems with brain function and maybe even leading to a real stroke.

Dr. Rod Raabe, a radiologist at Sacred Heart Medical center, led a team that investigated the use of a catheter with a tiny filter at the end of it, meant to collect the tiny bits of debris created from the procedure. They wanted to see if, by using the device with the filter, they could reduce stroke risk without damaging mental ability.

Reporting at the Society for Interventional Radiology in Toronto, Raabe discussed preliminary results of a study that eventually will include 100 people. Some study participants had no symptoms from the narrowing of their carotid arteries. Others were symptomatic with TIAs. Before and after the stenting, subjects underwent extensive neurological and cognitive testing.

What the researchers found surprised and delighted them. Not only was there no decline in function after the procedure, but the patients actually showed significant improvement in their tests six months after the stenting. Even though the asymptomatic patients had no known history of TIAs, clearly the drop in blood flow to the brain from the narrowed arteries was having some effect on brain function. They probably attributed their memory lapses and misplaced keys to a “senior moment,” or a spat with their spouse.

Some patients were able to resume activities they had given up – like working at a job or living independently.

Raabe told a reporter it was “like hitting a grand slam in your first at bat.” To be able to improve function, not just keep it from sliding downhill, was enormous. Clearly, there was no such thing as an asymptomatic patient. Most likely, the symptom creep was so subtle, it passed by unnoticed.

The study isn’t finished yet, and it hasn’t been peer reviewed or published, so the findings are still preliminary. But if this and future studies with the “brain-sparing” stent hold up, we will be paying a lot more attention to carotid artery disease. Because clearly, it can have a huge effect on peoples’ lives. Given the results of the study, this effect has been greatly underappreciated by those of us in the medical profession. And the benefits of this procedure most likely will turn out to far outweigh the risks.