A surgical procedure, called endarterectomy, has traditionally been used to remove fatty deposits inside the artery to prevent strokes. Interest is growing in using less-invasive interventional procedures to prevent and treat stroke.
Carotid Artery StentingCarotid artery stenting involves inserting a catheter (a small plastic tube) through an artery in the leg and threading it through the blood vessels to the blockage in the neck. A thin wire that has a collapsible umbrella-like filter device attached to its end is advanced via the catheter to a point just beyond the blockage.
When opened, the “umbrella” filters the blood flowing to the brain, preventing bits of plaque or blood clot from passing to the brain and causing stroke. The blocked artery is widened by inflating a tiny balloon inside the blood vessel. This pushes the plaque against the artery’s walls and makes way for the stent, which is inserted to prop open the artery. Once the stent is in place, the umbrella filter and catheter are removed.
Preventing Stroke by Closing the PFO A small opening, or hole, in the wall between the heart’s two upper chambers (atria) has been implicated in recurrent stroke. The patent foramen ovale, or PFO, as the opening is called, normally closes shortly after birth. But in about 25 percent of the population, it does not close securely. That means that blood can pass from the right atrium (the right upper chamber of the heart) to the left atrium (the left upper chamber of the heart) without first being filtered or oxygenated in the lungs. If blood entering the left atrium contains a clot or other impurities, the impurities could be carried by the blood to the brain, possibly causing stroke.
For patients at high risk of stroke, interventional cardiologists are using a catheter-based approach to implant a small closure device that seals the PFO shut. Once it is closed, unfiltered blood containing impurities cannot flow into the left atrium or to the brain.