 | Joseph P. Galichia, MD is the founder and Medical Director of the Galichia Medical Group, PA. He is an internationally recognized pioneer in the field of interventional cardiology. In the 70's, Dr. Galichia studied in Zurich, Switzerland with the inventors of the balloon angioplasty technique for treating heart disease. As a result of his experience, he was able to bring this historic technique back to the United States where he was one of the first physicians to perform coronary angioplasty here. A noted medical spokesman, he appears on a weekly Newstalk segment on KWCH Channel 12 and has a weekly syndicated radio talk show on KNSS 1330 AM every Saturday live from 11:00 am to noon. Dr. Galichia may be contacted by sending an e-mail to service@galichia.com |
Health & Medicine
2005-02-01 11:24:00
Blocked artery options
: I have a blocked artery in my neck and surgery has been recommended to prevent a stroke. I have heard recently that a balloon or a stent procedure may work just as well. Is this a possibility?
ANSWER: The FDA recently has approved the use of balloon angioplasty and stenting for patients who have blocked carotid arteries, which supply blood to the brain. These blockages account for between 25% and 40% of all strokes, and are common in the population. Stroke continues to be the third leading cause of death in the United States. Our approach to this problem has changed dramatically in the last decade. It was formally felt that surgery should be done only in patients who had symptoms of an impending stroke. Subsequently, we have done surgery known as carotid endarterectomy (CEA) earlier, and often in the absence of symptoms. Narrowings of 70% or greater now are usually addressed as a measure to prevent strokes. The surgical procedure (CEA) had low incidence of strokes or other complications. The long-term results also have generally been favorable. However, many of these patients have systemic illnesses such as coronary artery disease, heart disease, heart failure, kidney failure, diabetes, and lung disease. For these patients general anesthesia alone provides increased risk, and is commonly administered to patients undergoing carotid surgery. Comparison studies have been done in these high-risk patients and show that placing a stent in the vessel to correct the problem is actually slightly safer and has somewhat better long-term results. The carotid stent procedure is done with the use of a catheter placed in the groin and requires no incision. Technology has improved rapidly in this area and has been greatly simplified. We now identify the narrowed segment and place a filter wire across the blockage to prevent debris from flowing into the brain. This is followed by an initial short balloon dilatation and immediate stent placement across the area. This procedure usually takes between one half an hour and one hour and can be done with a short overnight stay. Most patients return to full activity within 48 hours, and their long-term risk of stroke is greatly reduced. Certainly, carotid stenting is rapidly gaining favor with patients and also appears to be less costly. Recurrence over a long period of time appears to be less as well. Medicare has funded this procedure to be performed in very few facilities in the country. Training programs are currently under way to teach physicians across the nation.
