Combating carotid artery disease with new surgery

DANBURY — When 78-yearold Sandra Jellinghaus first discovered that her left carotid artery was 80 percent blocked, she worried she might be in for an “ordeal” of a surgery.

The Watertown resident had found out through a Life Line mobile clinic screening, and later her doctor, that she had a severe case of carotid artery disease, or a buildup of plaque in one of the two main arteries in the neck that supply blood to the brain. Given her age and the anatomy of her arteries, she was also deemed a “high risk patient” for the typical open surgery to treat the blocked artery.

But, despite her initial concerns, Jellinghaus said she instead woke up the day after her procedure at Danbury Hospital “relieved” at how easy the process had been. She went home and back to her daily life less than 24 hours after the procedure.

Her easy recovery, in part, was because she was the first patient at the hospital to receive a new, minimally invasive option for high risk carotid artery disease patients, said her surgeon Dr. Alan Dietzek.

“I have to say, her recovery was amazing — it was like she never had surgery,” Dietzek said. “The process was quick, she had minimal anesthesia and those things make a difference.”

Danbury Hospital is the first in western Connecticut to offer the new procedure, called TransCarotid Artery Revascularization, and one of less than a handful of other hospitals in Connecticut and 10 percent of hospitals nationally to do so.

Hartford Hospital and the Yale New Haven Hospital Heart and Vascular Center also perform the procedure.

Dietzek said both open surgery and TCAR allow the patient to go home the next day. But, the new procedure, which uses a special device to place a stent in the artery, allows for the patient to be fully awake and takes about an hour as opposed to up to four hours for open surgery, depending on the doctor.

But, the main reason it can be a better option for high risk patients is that it reduces the chance of complications, particularly strokes, during the procedure. Strokes are often the first symptom of carotid artery disease because the plaque debris can break off and enter the brain.

Jellinghaus said this was one of the reasons she agreed with Dietzek that it would be the right choice for her.

“If there’s less chance of a stroke, that was a reassuring factor to me,” Jellinghaus said. “I’m glad that we were able to do it and that I was able to be the patient he did it on. Somebody has to be the first.”

The TCAR procedure allows the surgeon to make the incision below the affected area and not disturb the blockage or nerves close by, Dietzek said. Blood flow is also temporarily reversed during the procedure, meaning that any pieces of plaque that may detach from the wall of the artery are diverted away from the brain.

In traditional open surgery, the surgeon would open the carotid artery, remove the plaque and repair the artery.

Dietzek said studies so far show that TCAR has the same or lower rates of stroke than open surgery, though surgery is still considered the “gold standard” for treatment.

He added that he learned about the procedure from colleagues at hospitals who had done the trials for TCAR and felt confident bringing it to Danbury because the techniques are similar to those he already uses.

It also isn’t the first time the hospital has been at the start of breakthrough procedures, said Dietzek, who is also Western Connecticut Health Network’s medical director for vascular surgery.

“I don’t think most people realize that Danbury has a lot of firsts,” Dietzek said, noting that it is the only accredited vein center in Connecticut and one of less than 20 vascular labs recognized in all six accreditation areas. “We’re doing a lot of cool stuff here.”