The Texas Heart Institute (THI) at St. Luke's Episcopal Hospital has announced another major milestone in improved patient care, after performing its 1000th carotid artery stent procedure. Carotid artery stenting (CAS) has emerged as a less invasive treatment for stroke-causing blockages in the carotid artery, meaning patients generally have fewer risks for complications, shorter hospital stays and recovery times and less expense.
“It is apparent that CAS is rapidly becoming a valuable alternative to the more complicated traditional surgery as evidenced by the rapidly increasing use of this technology. I am extremely confident in this alternative mode of therapy that I can offer my patients”
The first CAS done in Texas was performed by the team of cardiologists at THI in 1998. At that time, the procedure was limited to those few who were critically ill, using devices that were developed for different arteries in the human body.
"Though we were successful with those other devices, there are stents available now specifically for the carotid artery. We've made some real advances," said Dr. Zvonimir Krajcer, Co-Director of the Peripheral Vascular Interventional program at THI at St. Luke's.
"It is apparent that CAS is rapidly becoming a valuable alternative to the more complicated traditional surgery as evidenced by the rapidly increasing use of this technology. I am extremely confident in this alternative mode of therapy that I can offer my patients," added Dr. Ali Mortazavi, Co-Director of the Peripheral Vascular Interventional program at THI at St. Luke's and Chief of Cardiology at the Kelsey-Seybold Clinic.
Dr. Neil E. Strickman, Co-Director of the Peripheral Vascular Interventional program at THI at St. Luke's, said, "At this point in time, we believe this is a real viable option for patients who, because of their medical condition, are either not candidates for the traditional surgery or who would be better off with this therapy."
"This is a huge step forward and we take a lot of pride in being in the forefront on this path to better, less invasive medicine," said Dr. Arup Achari of the Medical Clinics of Houston. "As a group, we all feel that it means we now can offer our patients an equally safe procedure for clearing these blocked arteries as what was only once available with surgery."
Stroke is the third most common cause of death in this country and approximately 50% to 60% of strokes are caused by carotid artery disease. The carotid arteries are located on each side of the neck and supply oxygen and blood to the front part of the brain where thinking, speech, personality, and sensory and motor functions are controlled.
When plaque (fat and cholesterol deposits) buildup occurs in these arteries, small particles may break off and can lead to a devastating stroke.
Prior to the FDA approval of carotid artery stents, stroke patients underwent carotid endarterectomy, a surgical procedure which involves an incision in the neck artery to remove the plaque. The artery is then sewn back together. The traditional surgery typically requires general anesthesia and a 2-to-3 day hospital stay.
CAS is a less-invasive option for clearing narrowed carotid arteries. Carotid artery stenting combines the use of a stent, which is a tiny scaffold-like cylinder, to open up the clogged artery, with the safety of a temporary filter (like a small umbrella) which is removed at the end of the procedure. Patients generally stay in the hospital overnight and are discharged the following day.
The preliminary results from a clinical trial, known as CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial), were presented at the 2010 American Stroke Association International Stroke Conference in San Antonio and found CAS to be as safe and effective as surgical carotid endarterectomy.
The interventional cardiologists at THI at St. Luke's have been involved in numerous CAS clinical trials and have helped pioneer the use of cerebral embolic protection devices, which are now required for all carotid artery stent procedures. Over the past decade, this team of well known cardiologists has contributed numerous peer-reviewed manuscripts and book chapters on carotid artery stenting and has presented the institution's results at national and international scientific meetings. Their work has been instrumental in the approval of carotid stents.
Currently, the Centers for Medicare & Medicaid Services (CMS) will only reimburse hospitals and physicians for stenting of patients with severe carotid artery blockage who are having active symptoms. For those who are without symptoms or those considered to be low-risk patients for an operation, CMS requires that they be enrolled in a clinical trial. Many private insurance companies see the advantage of this procedure and will discuss these cases directly with the physician involved prior to granting approval. We expect the CMS agency will soon grant approval for wider use of the stenting procedure as newer techniques continue to yield favorable results.
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