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.