Treatment of carotid artery stenosis

Narrowing of your carotid artery usually indicates vascular calcification of vessels affecting the entire body. Carotid artery stenosis, however, carries a risk of stroke, e.g., due to formation of small blood clots or breaking-up of calcification which then gain access to the bloodstream.

The risk of stroke increases with a stenosis of more than 60%,  and oral drug therapy usually no longer suffices. The narrow segment should be removed in such cases, even if you have had no symptoms up to that point.

This may be achieved by one of three options available at the University Hospital Zurich:

• Carotid angioplasty with stent: A stent (small metallic wire tube) can be advanced through a small incision in the groin with a wire which is advanced through other veins into the carotid artery. This stent may then be expanded to flatten the stenosis between the vessel wall and the stent itself. Small particles (calcium or blood clots) may detach in the worst case, causing a stroke, since the stent is not closely adapted to the vessel and looks like a small wire mesh. A small filter is therefore inserted into the artery before the stent is expanded, which can capture these particles. This prevents them from reaching the head and inducing a stroke. The small filter is removed once the stent is expanded. This procedure is known as stent angioplasty.
• Carotid stenosis – treatment by open surgery: Calcium is completely removed from the walls of your carotid arteries during carotid endarterectomy. An incision is made in the neck and your carotid artery is located. This vessel is then clamped for a brief period and then cut open to carefully remove the calcium or blood clot from the vessel wall. Special care is taken to remove all material from the carotid artery. Unlike a stent, the calcium or clot is completely removed and not pressed against the vessel wall. This reduces your risk of developing a stroke after the operation. Once the calcium has been removed,  the artery is carefully flushed and then closed with a patch made of bovine pericardium. This material is very smooth and similar to our vessel walls. The patch is sewn in by hand such that it adapts perfectly to the wall of your artery. The blood supply to your head is then released and the incision sutured. All that remains on your neck is a thin scar. Self-dissolving sutures are used which dissolve on their own after a few weeks; suture removal is therefore not required.
• Carotid stenosis – treatment by hybrid surgery (TCAR): We also offer a new procedure for the treatment of carotid artery stenosis. Transcarotid stenting (TCAR) combines stenting with a small incision in the neck. The lower part of your carotid artery is located and a small tube inserted into it as well as well as in the femoral vein. A machine is then used to suction the tube in the neck and redirect your blood from the neck to the groin. This causes the blood to flow out of the head and into the leg. A stent is then placed across the stenosis. Since blood now flows from the head into the leg, any small particles which  may have come loose are passed through the machine and filtered out. Blood subsequently enters your femoral vein. This trick significantly reduces the risk of stroke, which may be induced by such particles.

Procedure

• Preparation: You should let us know beforehand if you are taking blood thinners to enable us to decide which medication you should withhold and for how long before surgery. We will also decide whether you may continue taking your medication.
• Anesthesia: All procedures may be undertaken under local anesthesia, but general anesthesia is also available.
• Duration of the procedure: approx.1.5h for all three methods
• Duration of hospital stay: One day before the procedure, day of the procedure and one to two days thereafter.
• Aftercare: Suture removal is not required since we use self-dissolving sutures. A follow-up ultrasound of the carotid artery should be done after six weeks. This may also be done at the University Hospital Zurich. You may also have this done closer to home by a licensed angiologist. In general, we recommend that  this ultrasound examination is repeated at regular intervals, since other arteries may also be calcified.

Interdisciplinarity at the University Hospital Zurich

Numerous patients are treated by interdisciplinary teams every year at the University Hospital Zurich, comprising angiologists, vascular surgeons, neurologists and radiologists. Our doctors thus have extensive experience in diagnosing and monitoring the progression of carotid stenosis. In addition, we are the only clinic in Switzerland offering all three therapeutic procedures which are performed by experienced specialists.

Specialist in-charge