The non-cutting edge
ETMC Athens offers less invasive procedure to remove carotid artery blockages
By Toni Garrard Clay
Herschel Miller’s left arm was hurting so much, he could barely tolerate the pain.
“It mostly hurt at night when I was trying to sleep,” said the 85-year-old.
Miller likes to work around his home in Murchison, mowing, weed-eating, “you name it.”
So when the pain in his arm interfered with his daily life, he headed to the doctor and learned there was significant blockage in his left carotid artery. He was in danger of a stroke
Mr. Miller had been down the same road before. Almost three years ago, he had blockage removed from the carotid artery on the right side of his neck, through the standard, open-surgery procedure known as carotid endarterectomy.
This time, however, Mr. Miller was set to undergo a less invasive, non-surgical procedure to repair the potentially deadly blockage through the use of a stent.
The procedure is called carotid artery stenting, in which a physician – in this case Dr. John Wilcox, the interventional radiologist at ETMC Athens – inserts a catheter in through the patient’s groin and up to the site of the blockage in the neck.
Once in place, a filter – much like a tiny umbrella – is opened up against the artery walls to catch any “debris” that might break lose and otherwise float to the brain and trigger a stroke. When the filter is opened, a stent is then put in place to open up the blocked artery.
The stenting procedure requires local anesthesia and intravenous sedation.
The surgical procedure such as that performed on Mr. Miller in 2003 requires general anesthesia, allowing the surgeon to make an incision in the neck and carotid artery. The plaque and diseased portions of the artery are removed, and the artery is then sewn back together.
Clinical trials testing a carotid stent by the Guidant Corp. began three years ago, and the data to come out of the trial was encouraging.
In the summer of 2004, the Food and Drug Administration approved the company’s carotid artery stent system. (At least four other manufacturers have systems in clinical trials.) Then in March, Medicare approved the procedure for certain patients considered to be at high-risk for surgery and with blockage that also puts them at high risk of stroke.
“What usually happens when they approve a new procedure like this is at first they limit it to people in high-risk categories for surgery,” said Pam Grove, director of cardiology at ETMC Athens. “Then once it is determined the procedure offers significant benefits compared to surgery, they open it up to more people.”
In clinical trials, the carotid stents successfully opened blockages in 92 percent of 581 patients, according to the FDA. Complications of death, stroke and heart attack within 30 days or stroke in the area of the blockage after one year were 10 percent for stenting compared with 15 percent for surgery, the FDA says.
Grove explained that – under Medicare guidelines – to be able to insert a carotid artery stent, a physician must either have participated in the clinical trial sponsored by Guidant, attend one of the Guidant training courses, or provide verification that his or her level of expertise and experience is so extensive the training course is not necessary.
About six months ago, Dr. Wilcox was certified to perform the procedure.
“We’re lucky to have someone with his experience and ability,” said Grove. “He’s someone who makes you feel comfortable to work with.”
Dr. Wilcox has performed several of the carotid stenting procedures at ETMC Athens with good results in the last few months and anticipates he will perform many more as Medicare loosens its stringent guidelines for eligible patients.
The day after his stent is implanted, Herschel Miller rests fully dressed on his hospital bed at ETMC Athens, waiting for his ride home. He’s a bit sore, but can’t find much anything else to remark about.
“Dr. Wilcox is a very good doctor,” he says. “He knows what he’s doing.”
Miller doesn’t spend much time comparing the two procedures to remove carotid blockage. He just hopes to be able to return quickly to his life.
“I’ve got to get back to church,” he says. Then there’s the small matter of his yard.
“I’ve got me a brand new mower, and I’ve only used it once or twice.”
It’s all a matter of priorities.