Clinical Trial Takes New Approach To Carotid Stenting
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PITTSBURGH (KDKA) — After having surgery to open a blocked artery, John Eads is right back to his routine.
“We went in early in the morning on the 28th. And about 11 o’clock on the 29th, my wife and daughter picked me up,” he recalls.
UCLA researchers tested a new minimally invasive procedure on John to clear plaque from his carotid artery. The artery supplies blood to the brain and can lead to a stroke if it’s blocked.
Sometimes doctors place a stent, or a tube, into the carotid to hold it open.
“The catheter is tracked up from the groin, all the way to the chest, and from there into the neck,” explains Allegheny General Hospital vascular surgeon Dr. Satish Muluk.
For some people, this can be a technical challenge, especially if they have twisty, calcified blood vessels, or have had previous surgery or radiation to the neck.
The UCLA researchers say their new technique may be safer and faster because doctors can put a stent directly into the carotid artery from the neck instead of through the leg.
They have about 40 people in the clinical trial so far.
“We make a very small incision just above the collar bone enough to give us access and control about an inch length of the carotid artery,” describes Dr. Wesley Moore of UCLA’s David Geffen School of Medicine.
Normally, the carotid arteries carry blood toward the brain.
In this procedure, the doctors actually reverse the flow briefly with negative pressure. The theoretical advantage is that pieces of plaque won’t flow toward the brain and cause a stroke.
The other arteries to the brain make up for the temporary disruption until the stent is placed and flow is restored. But there is a theoretical problem as well.
“If you reverse flow to the brain, you might cause the brain to have a stroke just from the flow reversal,” says Dr. Muluk.
Doctors are testing the new the procedure in patients like John who are older and have especially clogged arteries — patients who might be at risk with a surgical procedure called carotid endarterectomy, which is the standard treatment.
“It’s still an open question as to whether you’re really helping patients any more than the traditional carotid surgery. Because with both you’re still making an incision in the neck,” Dr. Muluk points out.
“I think for an older person this type of operation is not that hard on you,” says Eads.