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A dramatic difference can be seen after a blocked carotid artery (left) is propped open with a stent (right) to restore blood flow to the brain.
William Cohen, 61, was on the road to a stroke when doctors at Baptist Hospital opened a blocked artery in his neck with angioplasty and a stent instead of surgery.
“I was really grateful that they caught this in time, that I didn’t have a stroke and I didn’t have surgery, either,” said Mr. Cohen, who owns a small freight forwarding company in Coral Springs.
When Mr. Cohen was diagnosed with a 92 percent blockage in one of the carotid arteries in his neck, his doctor recommended a surgery called endarterectomy. Surgery prevents strokes by removing plaque in the artery that can shed clots and other fatty particles directly into the brain.
But Mr. Cohen wanted an alternative. He sought an expert opinion at Baptist Cardiac & Vascular Institute, where he entered a clinical research trial of carotid angioplasty and stenting. Both procedures have been used for years in the heart. But they pose special challenges in the neck because physicians are working so close to the brain.
For example, even before Mr. Cohen’s angioplasty could begin, a tiny, removable umbrella had to be positioned inside his carotid artery, downstream from his blockage, to trap any fatty debris that could come loose and cause a stroke.
And, unlike heart stents implanted deep within the body, carotid stents need to be flexible and uncrushable as the neck bends and twists and is touched and pressed. Today’s carotid stents are made of a special material called nitinol, which holds its shape at body temperature.
The first such stent is expected to be approved by the FDA this year. Soon afterward, the Institute will become a training center for other physicians who want to learn how to use it.
That’s because Institute physicians have played a leading, national role in the development and testing of carotid stents. Barry Katzen, M.D., the Institute’s founder and medical director, helped organize one of the first national studies demonstrating that carotid stenting is equal to surgery in preventing strokes, with fewer serious complications. Until stents were developed to open carotid arteries, surgery was the only preventive treatment.
“Surgery has long been the gold standard for preventing stroke, and we expect it to continue to be an important option for patients with advanced carotid disease,” said Jose Alvarez, M.D., the Institute’s chief of vascular surgery.
For those who choose surgery, the Institute’s outcomes are outstanding: serious complications after carotid surgery are 50 percent lower than American Heart Association guidelines. Now the Institute is participating in clinical research sponsored by the National Institutes of Health.
“What’s exciting about this new research is that it enlists hundreds of the most skilled physicians across the country,” Dr. Katzen said. “We already know that stenting is less invasive than surgery. Now we will learn which procedure actually protects better against strokes in patients with advanced carotid disease.”
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