Minimally Invasive Procedures

Carotid stenting

Carotid stenting is a relatively new procedure done from the inside of the carotid artery. In this minimally invasive procedure, a small incision is made in the groin and a catheter is directed to the carotid artery in the neck. First, an embolic protection device is placed beyond the area of narrowing. This device prevents particles that may break off the area of narrowing during the stent procedure from reaching the brain and causing a stroke. After the protection device is in position, a small latticed metal tube called a stent is released at the site of carotid narrowing. The stent holds the artery open, improving blood flow to the brain. The stent also holds atherosclerotic plaque against the artery wall, preventing a possible source of stroke.

Recently, the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial was concluded and reported on in the New England Journal of Medicine. This trial found that patients with old age or serious medical conditions such as heart disease, kidney disease and diabetes had lower rates of stroke, death and heart attack following carotid stenting as opposed to traditional carotid surgery.

Los Angeles Brain and Spine Institute physicians were among the first in the valley to be certified and credentialed in carotid stenting. LABSI physicians have also been involved in setting up training and credentialing criteria for carotid stenting at several major hospitals. Additionally, our physicians are actively involved in carotid stent trials. These trials will study the efficacy of carotids stenting in both symptomatic and asymptomatic individuals with or without medical comorbidities. Though carotid stenting is now an approved procedure, enrollment in these trials will significantly increase the number of patients for whom this minimally invasive alternative to traditional surgery can be offered.

Carotid angioplasty and stenting is carried out under sedation, where the patient is given relaxing and pain killing drugs. The patient will remain in the hospital for one to several days.