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Chairman, Department of Neurological Surgery
The carotid artery is the main artery that brings blood to the brain, therefore one of the problems that occurs with the artery is what’s called carotid stenosis, a narrowing of the artery there that can occur due to atherosclerosis or hardening of the arteries. The problem is you can have a little particulate matter from the stenotic area that goes to the brain causing a stroke, therefore the key issue with evaluating and management of a patient with carotid stenosis is determining if this patient has a risk of having a stroke or not, how high the risk is and therefore proceed with the evaluation.
Patients with carotid stenosis can present in two groups, a symptomatic carotid stenosis or an asymptomatic carotid stenosis. In the symptomatic carotid stenosis the patient can have either a stroke or what’s called a TIA, a transient ischemic attack which is a small warning sign of a major impending stroke potentially. Those are one category of patients. The other category of patients are patients that present with absolutely no symptoms. It could be the doctor listens to the neck and notices what’s called a bruit, a little sound in there, alerting the doctor that there might be some narrowing of the carotid artery. And those are two different presentations.
There are different ways of evaluating a patient with carotid stenosis and they include noninvasive studies, which is an ultrasound or a CTA or an MRA or the gold standard which is angiography which is more invasive. If it’s done in a center that’s highly experienced with angiography it’s a very low risk type of procedure but what’s critical is determining the degree of stenosis. The higher the degree of narrowing or stenosis the higher the likelihood the patient will have a stroke.
As part of the evaluation of a patient with carotid stenosis the physician determines what’s the plan of action and in general there are two different ways, observation versus treatment. In the observation arm the determination must be based that the risk of treatment is higher than the risk of following the patient making sure that all the medications are optimized. However if treatment is what is selected there are two main ways of treating carotid stenosis. One is with open surgery which is carotid endarterectomy where the artery is opened, cleaned up and closed; or what’s called carotid stenting where from the inside in a minimally invasive manner a stent is deployed in the area of stenosis and it’s cleared up. Each one of them has advantages and disadvantages.
What is most important in the management of a patient with carotid stenosis is to make sure that we are able to tailor the treatment to the specific patient. Here at UPMC, our team of physicians is highly experienced in the management of these kinds of patients and therefore are able to optimize the results for the patient.
For more information, call us at (412) 647-6358, or visit us at neurosurgery.pitt.edu.