Medically Reviewed by Joshua A. Sibille, MD

Surgical procedures can dramatically reduce your chances of suffering a stroke. McLeod Vascular Surgeon Dr. Joshua Sibille explains how he diagnoses pre-stroke conditions and the vascular procedures used to avoid an approaching stroke.

Here are highlights of Dr. Sibille’s presentation:
Carotid artery atherosclerosis results from plaque developing in the arteries. These plaques can partially or even completely block the artery. There are plenty of patients walking around with an occluded carotid artery that have no problems, because other arteries help carry the blood. But over time, small blood clots travel up to the brain. Even a small emboli that effects a portion of the brain can have significant and profound effects on anyone.
 
A carotid ultrasound is typically the initial screening study. It’s noninvasive, very easy. If an ultrasound comes back positive, some type of additional imaging is performed for more detail.
Patients, who have been screened and found to have carotid stenosis, benefit from treatment and significant stroke risk reduction if their stenosis is over 70 percent. Anything under that, you’re better treated medically because your risk of stroke is lower.
 
Patients, who have had a stroke or patients who are having TIAs or amaurosis, gain significant benefit from treatment, even if the artery is less than 50% clogged.
 
What type of treatment?

• An endarterectomy is a surgical repair, in which we open the neck and artery, scoop the plaque out and sew a patch in to widen the artery and decrease the risk of the blockage recurring. It has a very low stroke rate – 1% or less. It can significantly decrease your risk of stroke by up to 17%. The downside is it’s surgery. So, a lot of these patients with carotid artery disease also have heart or lung disease, making open surgery riskier.
• Carotid stenting tends to be for high-risk patients, patients who have already had surgery in the neck, either a previous carotid endarterectomy or another type of surgery. Most likely we see patients who have had head and neck cancers. It does have a higher risk of stroke, but still only about 2%. It has lower risk of heart attack.
• A newer method is Flow Reversal Stenting. When you do a standard carotid stent, you place a filter near the brain to catch any blood clots that may break off. This technique is different. It reverses the blood flow away from the brain, carrying any blot clots that break loose through a filter that leads to a vein in the legit represents the lowest rate of stroke — about 1.4%  It’s still for primarily for higher-risk patients, but in time this may actually be a better alternative for all patients.

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