If you only have a hammer you tend to see every problem as a nail.
Some vascular “specialists” perform one or two kinds of vascular interventions, so their patients tend to get those treatments. Vascular Surgeons are trained in all treatment modalities and are able to perform every type of procedure skillfully: open, complicated surgery and minimally invasive, in-office endovascular procedures. Some patients need one, some need the other, while many need no surgery at all. Vascular Surgeons are “treatment agnostic,” that is, they do not prefer any treatment over another.
Some types of surgeons come into your life to perform a procedure, make sure you heal and then leave; that’s their role. A vascular surgeon may be someone who treats you on an ongoing basis for decades. A vascular surgeon very often has long-term relationships with patients because vascular disease can be a long-term condition.
At Western Vascular Institute, patients will get the best treatment for their particular needs in a caring and safe environment by a vascular surgeon with a full toolbox of treatment options!
Strokes are caused by an interruption of blood flow to the brain and are classified by the type of blood flow interruption as listed below.
Ischemic stroke – occurs when blood vessel blockage prevents blood flow to the brain due to a plaque build-up in the carotid arteries.
Hemorrhagic stroke – occurs when the vessel ruptures inside of the brain and bleeds.
Transient Ischemic stroke or TIA – is a temporary blockage or mini-stroke which can cause permanent damage and are a sign of more severe stroke in the future.
Like Peripheral Arterial/Vascular Disease, Carotid Artery Disease is a narrowed blood flow through the vessel. This narrowing or blocked vessel becomes occluded by fatty deposits of plaque built up along the vessel wall leading to atherosclerotic disease. The Carotid artery is the primary source of blood to your brain. Therefore, a narrowing or blockage in the carotid artery is a serious complication and requires thorough and appropriate diagnosis and treatment.
Many people with Carotid Artery Disease do not experience symptoms even with quite a bit of arterial blockage. Generally, this condition is found after the patient experiences a stroke or by a routine patient examination.
Generally, Carotid Artery Disease is caused by atherosclerosis, where a build-up of plaque in the arteries reduces the flow of blood or blocks the flow entirely. This lack of blood flow and reduced oxygen supply to the brain can lead to stroke.
Risk Factors include:
Sedentary lifestyle, Overweight obesity, Diabetes, smoking, high cholesterol levels, high blood pressure, Family history, high fat diet, and age above 75 are all factors.
Diagnosis of Carotid Artery Disease is generally diagnosed through thorough physical examination and medical history. Your physician will also most likely be looking for a (bruit) swooshing sound in the carotid artery that is indicative of a narrowed artery. A Carotid Artery duplex ultrasound scan will also be performed to assess the flow of blood through the artery as well as the pressure.
The reason for the treatment of carotid artery disease is to reduce or mitigate the possibility of stroke.
For mild blockage:
Lifestyle changes such as eating a healthier diet, reducing salt intake, exercising regularly, losing weight, and quitting smoking are all ways that patients themselves can manage the disease and reduce the chance of blockage and stroke.
Medications may be given to lower the amount of cholesterol in the blood and lower your blood pressure. Additionally, blood thinner medications may be given to prevent blood clots.
Carotid endarterectomy – generally performed when there is a blockage of 50% or above accompanied with symptoms such as a stroke.
TCAR – Western Vascular Institute is pioneering the use of a breakthrough technology called TransCarotid Artery Revascularization (TCAR) to treat patients with carotid artery disease who are at risk for open surgery. While any repair of the carotid artery carries some risk of causing a stroke because of the repair itself, TCAR was designed to help minimize that risk by keeping potential stroke-causing fragments away from the brain.
Carotid angioplasty/stenting – This procedure is performed to treat narrowed or occluded carotid arteries. In this procedure, the Vascular Surgeon inserts a wire through the groin and guided via x-ray imaging to the carotid artery. Once there, the balloon is placed to expand the narrowed section, and a stent is left in place afterward to maintain the vessel diameter and allow the blood to flow through the artery.
Atherosclerosis – is a disease process that leads to the hardening or clogging of arteries. The build-up over time of substances such as fat, cholesterol, & calcium, collectively called plaque, narrows the artery and restricts the amount of blood able to pass through the arteries, and provides oxygen-rich blood to the body. This stenosis or narrowing of the artery can lead to serious problems such as stroke, amputation, heart attack, and death.
What is Carotid Artery Disease? Dr. Dawn Olsen Vascular Surgeon and Kailin George physician liaison discuss the signs, symptoms, causes, & treatments of carotid artery disease. Additionally, as seen below are some photos taken from a recent TCAR or Trans Carotid Artery Revascularization procedure performed by Dr. Dawn Olsen on a patient in the hospital. It can be clearly recognized where the carotid artery had become nearly occluded prior to the procedure and post-procedure including stenting the artery had become nice and open allowing for optimal blood flow to the brain. Also of note is the photo where plaque filtered out through the TCAR device can be seen in abundance.
A small incision is made just above the collar bone to expose the common carotid artery. A soft, flexible sheath is placed directly into the carotid artery and connected to a system that will reverse the flow of blood away from the brain to protect against fragments of plaque that may come loose during the procedure. The blood is filtered and returned through a second sheath placed in the femoral vein in the patient’s thigh. The Neuroprotection system allows balloon angioplasty and stenting to be performed while blood flow is reversed. After the stent is placed successfully to stabilize the plaque in the carotid artery, flow reversal is turned off and blood flow to the brain resumes in its normal direction.
Silk Road’s TCAR Procedure is designed to protect the brain from most sizes and types of embolic debris when introducing interventional devices into the carotid artery. Small emboli, not large enough to cause a major stroke, can still cause a minor brain infarction and impact cognitive function.1-3 A sensitive imaging technology called Diffusion Weighted -Magnetic Resonance Imaging (DW-MRI) can be used to detect these small brain infarctions.
TCAR is a surgically inspired procedure and is designed to mimic the arterial access and safeguards of surgery. In carotid artery surgery, the arteries are clamped above and below the blockage to block blood flow and prevent plaque from traveling to the brain during treatment. Similarly, the ENROUTE® Transcarotid Neuroprotection System isolates the blockage from forward blood flow during stent placement by actually reversing blood flow away from the brain. Because the flow reversal method does not rely on a distally placed filter to capture emboli before they reach the brain, it collects both small and large debris.
Only a very limited number of specialized surgeons including, Vascular Surgeons, who have all treatment modalities available as part of their training and scope of practice are able treat a patient by performing a carotid endarterectomy (CEA). A carotid endarterectomy is performed to remove a plaque build up in the carotid artery to allow for greater flow of blood through the artery and reduce the risk of stroke.
This procedure is generally done when there is a significant blockage of 50% or greater to the artery.
See a Western Vascular Institute vascular surgeon to discuss all treatment options available for Carotid artery disease, including a carotid endarterectomy (CEA).