Stroke remains the third leading cause of death and first leading cause of long term disability among adult Americans. In the United States approximately every forty-five seconds someone has a stroke. About eighty percent of strokes are ischemic (meaning it is due to a lack of blood supply to the brain) and fifty percent of these ischemic strokes are caused by a significant carotid artery (neck artery leading up to the brain) stenosis (narrowing). The primary cause of ischemic strokes is the development of plaque (cholesterol and fat accumulation) and then subsequent thrombus (blood clot) formation and/or debris that travels up the carotid blood vessels and occludes one of the blood vessels supplying the brain. Cholesterol and plaque typically develops at the opening or branching of blood vessels. The internal carotid artery travels up the neck to supply the middle cerebral and anterior cerebral artery in the brain, and if occluded can lead to a significant stroke.
Carotid endarterectomy (which is a surgical procedure where cholesterol and plaque is scraped out of the neck arteries) has been the most common surgical procedure performed in the United States and the gold standard for preventing ischemic strokes. Large randomized trials performed over the past twenty years have demonstrated the superiority of carotid artery surgery over medical therapy (medications) in preventing ischemic strokes in patients with either a symptomatic or an asymptomatic severe carotid artery narrowings.
Carotid artery angioplasty and stenting has been around for about twenty years but initial procedure results were not favorable. Early angioplasty/stenting procedures revealed that during balloon inflation little pieces of the carotid plaque can dislodge and can travel up into the brain blood vessels and lead to a stroke. Studies utilizing an embolic/distal protection (little umbrella or filter) device during carotid stenting found that between 7 to 145 particles would have traveled into the brain circulation during each procedure if these filters were not used. Recent improvements in the stent technology and use of embolic/distal protection devices have now demonstrated that balloons and stents for carotid disease may be a beneficial alternative to surgery especially for high risk patients.