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Game-changing technology: Cutting the risk of stroke in half

ALBUQUERQUE, N.M. — Dudley Sue Bock, 75, received the shocking news last July that she had a 70 percent blockage in one of the two arteries that provide blood to her brain.

In October, Bock became one of the first patients in the Southwestern U.S. to undergo a new stenting procedure at New Mexico Heart Institute that restored blood flow through carotid artery on the right side of her neck.

The procedure, called Transcarotid Artery Revascularization, or TCAR, is intended to lower the risk of stroke or heart attack, particularly in older patients, while patients are on the operating table, Heart Institute surgeons said.

“The question here is, is there any way to limit that stress on the heart, but keep the procedure as safe and effective” as conventional surgery, said Dr. Steve Henao, the Heart Institute’s chief of vascular surgery.

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The Heart Institute is one of about 40 medical centers worldwide participating in a study to evaluate the effectiveness of TCAR, which was approved by the U.S. Food and Drug Administration in 2015 for use in patients at high risk of stroke.

The Heart Institute has performed TCAR for about 20 patients since October.

Surgeons perform TCAR by opening a small incision in the neck, allowing them to place a stent directly into the carotid artery using a thin, flexible wire, Henao said.

A key advantage of TCAR is that the procedure can be performed in 15 minutes or less – a fraction of the time required for conventional surgery.

The brevity of the procedure cuts by half the risk of the patient having a stroke or heart attack, “and it does it with a much more efficient operation” than the standard surgery, he said.

New Mexico Heart Institute physicians Trent Proffitt, center, and Steve Henao, left, chat with Dudley Sue Bock, right, on March 21 in Albuquerque. Proffitt performed a new procedure called Transcarotid Artery Revascularization on Bock to prevent strokes. (Marla Brose/Albuquerque Journal)

New Mexico Heart Institute physicians Trent Proffitt, center, and Steve Henao, left, chat with Dudley Sue Bock, right, on March 21 in Albuquerque. Proffitt performed a new procedure called Transcarotid Artery Revascularization on Bock to prevent strokes. (Marla Brose/Albuquerque Journal)

“It is definitely something we’re talking about as a game-changing technology,” he said.

An estimated 795,000 people a year have strokes, and more than 130,000 die, according to the U.S. Centers for Disease Control and Prevention. Carotid artery occlusive disease, or blockage of the carotid artery, is responsible for up to 20 percent of strokes.

The “gold standard” treatment for carotid artery disease is a decades-old surgery called carotid endarterectomy, or CEA, in which surgeons slice open the artery and physically scoop out the blockage, Henao said.

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CEA is recognized as a safe, effective surgery, but it involves clamping shut the artery for up to 45 minutes, requiring the patient to rely entirely on blood delivered by the other carotid artery, he said.

To maintain blood flow, surgeons must increase a patient’s heart rate and blood pressure to force blood from one hemisphere of the brain to the other, putting added stress on the patient’s heart. Patients 75 and older too often have difficulty tolerating that stress, Henao said.

With TCAR, surgeons temporarily reverse the flow of blood in the carotid artery, preventing arterial plaque from entering the brain and causing a stroke, he said. Surgeons then filter the blood before returning it to a vein in the groin.

“All the crumbs, all the crystals, all the debris has nowhere else to go but away from the brain, out of the body, and into the filter,” he said.

A smaller study that led to FDA approval for the procedure found that TCAR cut the risk of a stroke or heart attack to 1.4 percent, compared with a risk up to 3 percent for standard surgery.

“That may not sound like much, but we’re cutting (the risk) by half,” said Dr. Trent Proffitt, a vascular surgeon who performed Bock’s procedure.


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