In May 2011, The Food and Drug Administration approved carotid artery stenting for use in standard risk patients. Previously, only patients at high risk for surgery were approved for the procedure. High risk patients are typically older, sicker or have abnormalities of their neck that make it difficult for a surgeon to operate. Dr. William Julien was one of the first endovascular surgeons in the region to perform this procedure.
More than 60% of United States patients are standard risk. Now patients who need carotid revascularization have the option of choosing a minimally invasive endovascular procedure rather than traditional open surgery known as an endarterectomy, which is a major surgical procedure performed under general anesthesia.
During carotid stenting, a tiny incision the size of a pencil head is made in the patient’s groin and the doctor inserts a specially designed guide wire with a filter that is placed beyond the site of the narrowing or blockage in the carotid artery. Once the filter is in place, a small balloon catheter is guided to the area of the blockage. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened to increase blood flow. The balloon is removed and a stent is placed inside the artery to widen the opening and support the artery wall. The final step is to remove the filter device along with any particles that may have been trapped during the procedure. The patient typically spends one night in the hospital and is able to resume their normal activities immediately.