There are more than 700,000 strokes in the United States yearly with carotid artery disease being an important cardiovascular cause. Not surprisingly, the risk factors for developing carotid artery disease overlap those for coronary artery disease including advanced age, tobacco use, diabetes, hypertension and hyperlipidemia. Up to half of those with PAD will have significant carotid artery disease and about half of those who have severe carotid artery disease will have significant coronary artery disease. While the medical therapy with aspirin, blood sugar and blood pressure control and lipid lowering therapy are important for all patients with carotid artery disease, surgical carotid endarterectomy (CEA) has been the standard of care in reducing the risk of stroke in both symptomatic and asymptomatic patients with severe carotid stenosis. As the treatment of stroke and carotid artery stenosis continues to evolve however, there is a growing body of evidence that carotid artery stenting with emboli protection (a filter-type device placed in the carotid artery to catch plaque and debris that might be dislodged during stenting) may be an alternative option to treat certain high risk patients with severe carotid artery disease. Current candidates for carotid artery stenting include patients who have recurrent narrowing after surgical carotid endarterectomy, prior neck radiation therapy, prior radical neck dissection, high surgical risk due to concurrent medical problems or blockages that can not be easily reached by surgical techniques. Ongoing studies and registries at Johns Hopkins are comparing carotid artery stenting (with emboli protection) to conventional carotid artery surgery with the hopes of expanding the pool of eligible candidates for carotid artery stenting in the future. We are currently utilizing and investigating this treatment option for specific patients with severe carotid artery disease. |
