Procedures to clear carotid artery plaque
DEAR DOCTOR: My cardiovascular surgeon tells me medicine has mostly abandoned shunt and stent placements as a solution to carotid artery plaques. Instead, doctors are returning to the older “Roto-Rooter” procedure. What’s your take on this? DEAR READER: The common carotid arteries are major suppliers of blood to the brain. You have two of them, and you can feel their pulse at the side of your neck. They split in the neck to become the external and internal carotid arteries, which supply blood to the majority of the brain.
Turbulent blood flow at the location of these splits contributes to the formation of plaque within the internal carotid arteries, as do other factors like high blood pressure, diabetes and smoking. This plaque can rupture and cause closure of the artery; or a portion of the plaque can break off and lodge in a smaller artery. In either circumstance, a stroke occurs. Thus, if the internal carotid artery is significantly closed with plaque, it is necessary to clear the plaque.
What you describe as a Roto-Rooter procedure is called a carotid endarterectomy. A surgeon performs an endarterectomy via an incision in the neck. The surgeon frees the plaque from the lining of the artery and removes it before closing the blood vessel.
Carotid artery stenting is a different type of procedure in which the surgeon places a catheter into a major artery (usually the femoral artery in the groin), then moves it via wire up to the internal carotid artery. The surgeon then dilates the artery (if necessary) and lodges the stent into its lining.
Research suggests that the carotid endarterectomy is clearly the better procedure, especially if you’re over 70.
But each patient is different. In difficult surgical situations, stenting remains a good alternative.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
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