Stroke Prevention – Carotid Artery Disease



so daughter disease a very common problem that we deal with and it actually is due to a buildup of plaque or atherosclerosis in the carotid arteries the arteries in the neck that supply the brain and their plaque when it builds up can do two things it can decrease blood flow just by narrowing the artery and the second can happen is little particulates can actually break off from that plaque travel up the artery into the brain causing a stroke about half of the patients will actually present with some symptom first and either they have what we call a mini stroke and you may hear the term T IA or transient ischemic attack when a little piece breaks off it blocks off a very small artery to a portion of the brain and that resolves sometimes in fifteen to thirty seconds and sometimes can last up to 24 hours which would be the definition of a transient attack the second could be a true stroke unfortunately it's either a bigger piece that's broken off and it blocks a bigger artery that then stays blocked and if symptoms last for more than 24 hours then they have actually had a stroke that's the bad news the good news is many times patients will either have risk factors for artery disease in other places they may have diagnosis of artery disease in other places or they may have a really good doctor who listens to their neck and here's some funny sounds and then sends them for a diagnostic study which would generally be an ultrasound non-invasive test cheap easy to do and they found a narrowing if you have heart disease if you have artery disease in your legs if you have risk factors such as a bad family history of strokes or heart attacks or vascular disease if you have high cholesterol if you're a smoker so all of these are risk factors for atherosclerosis and if you have one of those you should ask your doctor to listen to the neck and if there's any abnormality certainly should be getting a test done so you need to control all of your risk factors 1 2 & 3 I tell patients are smoking smoking smoking so you must stop smoking second is you need to treat your cholesterol if your cholesterol is high it certainly needs to be treated within guidelines you can make an argument now that even if your cholesterol is normal you should be using medicines called statins which actually not only decrease cholesterol but also have a plaque stabilization effect where they make a plaque that may be a little bit irregular or maybe a little bit rough that is prone to sometimes embolizing they smooth out those plaques we also need to use medicines called antique light light agents and that's really aspirin they've been proven to decrease mortality so death from strokes and heart attacks in patients with carotid disease and they've also been proven to just decrease the incidence of how many T is you might have so aspirin is a very important medicine and patients sometimes don't understand how life-saving aspirin can be once those things are all done then we can start talking a little bit about what are the ways to actually treat the blockage and so we can use the term generically carotid revascularisation so getting more blood through the carotid artery to the brain by either removing the blockage which has been tried and true left for the last 70 years we've been taking plaques out of the carotid artery it's a it's the most commonly performed major vascular procedure that we do you make an incision in the neck and you actually scrape the plaque out of the arteries and close up the artery trible true but it's a major operation and there are some risk factors along with it there's an anesthetic risk factor there are nerves in the area that sometimes can be pulled on stretched upon with retractors that sometimes can leave you with a little bit of hoarseness sometimes can lead with trouble swallowing there's oftentimes some swelling that will take a few weeks to resolve after a carotid endarterectomy but it is the gold standard and the tried-and-true method to do that so this new t'car procedure that we're gonna talk a little bit about today I'm sure is where we actually make a little incision right at the base of the neck or right over the collarbone and we actually put our working sheath or this little straw basically that will work through right into the carotid arteries we actually then create flow reversal in the carotid artery so instead of having blood going towards the brain by clamping the carotid artery and connecting that sheath in the neck to a venous sheath in the groin we now create reversal of flow and so the Bloods coming backwards it comes out of the arterial sheath it goes through a little filter in the tubing and we give the patient the blood back so there's no blood loss there but what we do have happened is when we are doing anything to our blockage so we don't have to put a filter in because the blood is coming backwards we don't need to protect the brain there we don't do anything to the blockage until we've created this reversal of flow and so the stent procedure becomes very short and sweet you know old partner of mine told me that anything you do to the carotid artery is a 50 cent operation with a potential million-dollar complication and that's really true when everything goes well with carotid intervention it's not a big deal but the big deal is if something goes wrong but I think for most straightforward carotid lesions I don't see any reason why t'car would not be an option you

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