Until recently, vascular surgeons had only one option when treating the buildup of plaque in the carotid artery of the neck—namely, surgically removing the blockage in a procedure called endarterectomy. But now the FDA has approved a new alternative procedure, carotid artery stenting—and Mount Sinai is one of the sites that have received approval to perform the new procedure.
Carotid artery stenting provides a benefit over endarterectomy. The advantages, especially for high-risk surgical patients, include not needing general anesthesia, shorter procedure time, no surgical incision, shorter hospital stay, and no risk of nerve injury. Several recent trials have shown that stenting is equivalent or better than endarterectomy for high-risk surgical patients. Trials are currently underway at Mount Sinai for low- and moderate-risk patients.
This procedure is performed in the neuro-interventional suite, which consists of a bi-plane angiography equipment that creates images in two views during the procedure. The procedure is similar to inserting coronary stents in cardiac disease. The narrowed vessel is identified during an angiogram. An umbrella- like device is then placed past the area of narrowing so that any debris that may be generated during the procedure can be captured. A wire mesh stent is then opened in the narrowed area and a high-pressure balloon is used to enlarge the narrowed segment of the vessel. Patients are admitted overnight for observation, and then sent home in the morning.
Lateral view of common carotid artery angiogram shows severe stenosis of the internal carotid artery with ulcerations.
Lateral view of common carotid artery angiogram after stenting show no residual stenosis, the ulcerations are no longer seen.
