Stroke and Atherosclerosis
You may be aware that heart attacks are caused by a narrowing or blockage of the coronary arteries. The same process can happen in arteries that bring blood to the brain (the carotid and vertebral arteries) or arteries within the brain itself (cerebral arteries). Whenever any of these arteries become narrowed or blocked, your brain may not get the blood supply and oxygen it needs. The result is stroke, also known as a cerebral vascular accident (CVA).
Doctors have traditionally treated narrowed arteries of the brain through medication, but neuroendovascular procedures are now available if medication alone fails to work.
These procedures involve guiding balloons or stents up through the femoral artery in your leg toward the narrowed arteries in your brain. Upon reaching their target, the balloons are inflated or the stents expanded to prop open the narrowed passageways. With blood flow re-established, your doctor removes the balloons, leaving the stents permanently in place. You can usually go home the next morning, following overnight observation.
Acute management of stroke
Several intravenous, clot-busting medications are now available to treat strokes within just a few hours of the onset of symptoms (acute stroke). Using neuroendovascular technology, your doctor can deliver these medications directly to the affected artery in your brain. Other interventional approaches are available, including devices that physically extract (vacuum out) the clot. Restoring blood flow to the brain is the most effective treatment for a stroke.
Restoring blood flow through the carotid artery
Until recently, surgeons have had only one option when treating a build-up of plaque in the carotid artery — surgically removing the blockage in a procedure called endarterectomy. However, the FDA has now approved an alternative procedure, carotid artery stenting, which Mount Sinai is approved to perform.
Carotid artery stenting is similar to the use of coronary stents in treating cardiovascular disease. After identifying the narrowed artery during an angiogram, your physician will enlarge the narrowed section with wire-mesh stents and high-pressure balloons to enlarge the narrowed segment of the vessel. This will improve blood flow to the brain and reduce the possibility of future strokes. Most patients stay overnight for observation and go home in the morning.
Several clinical trials have shown that carotid artery stenting is equivalent to or better than endarterectomy for high-risk surgical patients. Advantages of carotid artery stenting include:
- No need for general anesthesia
- Shorter procedure time
- No surgical incision
- Shorter hospital stay
- No risk of cranial nerve damage
Trials are currently underway at Mount Sinai to determine whether carotid artery stenting is safe and effective for low- to moderate-risk patients.