From an interview with
Joshua Sibille, MD, Heart & Vascular Surgeon
McLeod Vascular Associates
“The carotid arteries are a pair of arteries that travel up through the neck from the chest and supply the majority of the blood to the brain. The artery is split in the mid portion of the neck, and due to that splitting, plaque can develop there over time. As that plaque develops, pieces can break off and travel up to the brain. You can also form clots on that plaque called platelet aggregates, and if pieces of that break off and travel through to the brain, that can cause a stroke.
Initial evaluation for carotid artery stenosis is usually done with an ultrasound. Patients who are found to have carotid artery stenosis are initially treated with risk factor modifications; we ask diabetic patients to control their diabetes, and we encourage patients to quit smoking. These patients are also usually started on statins and antiplatelet medications, both of which significantly reduce the risk of stroke.
Patients often require intervention if they have more severe stenosis because their blockage is large enough or because they’ve had symptoms of strokes or TIAs — sometimes called mini-strokes. The gold standard treatment for years has been carotid endarterectomy, which is an open surgery in which the artery is open, cleaned out and patched. This has been shown to have a good outcome long term for most patients. Within the last five to 10 years, a new technique of stenting the carotid artery called TCAR has become popular, and McLeod Health is one of the leaders in the South Carolina area for doing this procedure.
The traditional technique for a carotid artery stenting involved going from an artery in the groin. This involved passing multiple wires and devices past the blockage in the artery. Every time a device or a wire passes the blockage, we ran the risk of a piece of that plaque breaking off and going to the brain and causing a stroke. However, the TCAR procedure is unique in that it actually isolates the blood flow to the brain. A tube called a sheath is placed in the carotid artery beneath the blockage as well as in a vein in the groin. These two sheaths are connected via a filter device. What this does is actually reverses the direction of flow in the carotid artery; instead of going to the brain, it actually comes out through the tube into the filter device and back through the vein to the patient. This procedure is beneficial in that it causes very little blood loss and extremely low risk of stroke.”