Carotid Stents On the Rise
The traditional treatment for narrowed neck arteries is carotid endarterectomy (CEA), a surgical procedure done on about 150,.000 Americans per year to remove plaque from the inner lining of arteries. Now stents are increasingly used in carotid arteries after having proved their effectiveness in the heart. Dr. Marc Mayberg, executive director of the Seattle Neuroscience Institute at Swedish Medical Center., was quoted in the Boston Globe as saying: ”the procedure is less invasive and recovery is faster than with endarterectomy.” Dr. Mayberg however voiced concerns that the procedure may be applied in cases where it is not necessary, while he added that “there is little scientific data yet to show that stents are an effective way to prevent strokes, while there is such data for endarterectomy.”
Carotid stenting is not new but one of its early tradeoffs was a risk of fatty debris travelling to the brain and triggering strokes. Debris filters now make the procedure safer (see FDA’s approval of the Guidant Acculink carotid stent system in August 2004). Then in March 2005 Medicare expanded coverage of Percutaneous Transluminal Angioplasty (PTA) of the carotid artery concurrent with stent placement to patients who are at high risk for endarterectomy. It remains to be seen whether carotid artery stenting (CAS) should be used in patients with moderate risks of stroke and no overt symptoms. The US National Institute of Neurological Disorders and Stroke (NINDS) of the US National Institutes of Health (NIH) is trying to find that out through its CREST clinical trial.
May 15, 2006 Related topics: Surgery