Cardiovascular Institute

Both carotid endarterectomy and carotid stenting are effective treatment options for carotid stenosis. Carotid endarterectomy is the traditional gold standard method of treating carotid disease. Carotid angioplasty and stenting is a new method that may be a better choice for patients under specific circumstances. Our division offers both options, and we choose the procedure based on individual patient characteristics and patient preference.

The standard surgical treatment for carotid artery disease is carotid endarterectomy, a procedure performed using local or general anesthetic, depending upon the particular situation. During the procedure, a surgeon makes an incision in the neck at the location of the blockage, opens the carotid artery, removes the plaque and any other diseased portions, and sews the artery back together to allow blood flow to the brain. This low-risk, long-lasting treatment allows many patients to leave the hospital as early as the same day or the day after the procedure.

Endarterectomy may not be an option for high-risk patients, however — for instance, those with other anatomic risks factors, previous neck radiation, severe congestive heart failure, unstable angina, recent myocardial infarction, carotid occlusions on both sides, or previous endarterectomies with restenosis. Carotid stenting may be an option for these patients.
 
Carotid Stenting

Allegheny General’s specialists are considered among the finest in the country at carotid stenting — an innovative new treatment approved by the U.S. Food and Drug Administration in 2004. Allegheny General was the first in the region to become Medicare-certified in providing carotid stenting, and also opened Pittsburgh’s first carotid stent center in 2005. Since then, its physicians have hosted professionals from around the world, helping them perfect this remarkable new technique.

Carotid stenting is a minimally invasive procedure that uses a specially designed catheter to dilate the narrowed artery, so a stent can be placed inside to open the blockage. The stent then stays in place, as a support to keep the artery open, and the artery heals around the stent. Through this program, patients also may receive embolic and distal-protective devices — in essence, stents with medications that prevent future formation of plaques or clots in that area. Carotid stenting represents a promising, non-surgical option to treat carotid artery disease.

Allegheny General Hospital's leading role in carotid stenting has developed from a commitment to rigorous information management and outcomes research, evaluated on a regular basis by a multidisciplinary oversight committee.