The treatment of carotid stenosis is best carried out by physicians from several specialties
At the USZ, the initial assessment of symptom-free patients is usually carried out in the Department of Angiology, as the arteries throughout the body are usually altered in patients with carotid stenosis and should be examined for additional arterial diseases. As soon as neurological symptoms occur, a neurological examination should be carried out. Radiology is involved for further diagnostics and vascular surgery for any surgical treatment.
Treating carotid stenosis - a change in lifestyle
If the carotid artery is not yet so severely narrowed (less than 60 percent) and you have no symptoms, we recommend treatment with medication and a change in lifestyle first. The measures are the same as those you can take to prevent vascular calcification: Don’t smoke, get plenty of exercise and eat a healthy diet. Blood pressure, blood sugar and blood lipids should also be adjusted to healthy levels, if necessary with medication. The aim is to slow down the progression of arteriosclerosis. In addition, blood-thinning medication from the platelet inhibitor group, such as acetylsalicylic acid (ASA), can reduce the risk of blood clots and thus a stroke. You must visit your doctor regularly and have the condition of your carotid artery checked by ultrasound. If it narrows further, further treatment follows. There are two different methods for this, which have comparable chances of success.
Carotid angioplasty with stent (minimally invasive)
After administering a local anesthetic, the doctor inserts a catheter with a small wire tube (stent) into the narrowed carotid artery via the inguinal artery, unfolds it and, depending on the success of the procedure, can expand the stent with a balloon. The stent serves as a “vascular support”. A filter is usually placed higher up in the artery as protection to catch any blood clots or calcium particles. After the so-called stent implantation, the filter is removed from the artery. This procedure is called carotid angioplasty with stenting. You will remain awake during the procedure. The procedure is usually followed by a short stay in the monitoring ward (IMC) so that blood pressure and pulse can be continuously monitored and you can usually go home the day after the procedure.
The advantages compared to surgery: the blood flow is not interrupted and there is no need for a neck incision or general anesthesia. The disadvantage: deposits can come loose and cause a stroke. As mentioned, this risk can be reduced by a filter system.
The treatment is particularly suitable for patients with existing underlying diseases, for example of the heart, lungs or kidneys. Such patients have an increased surgical risk and can benefit from minimally invasive treatment.
Experience in diagnosis and follow-up
Numerous ultrasound examinations of the carotid artery are carried out annually at the Clinic for Angiology. As a result, our doctors have extensive experience in the diagnosis and monitoring of carotid stenosis. In addition, treatment at the USZ is carried out on an interdisciplinary basis with specialists from the fields of angiology, vascular surgery, neurology and radiology.
Carotid stenosis: treatment by means of open surgery
In this classic operation, the vascular surgeon exposes the carotid artery via an incision in the neck, clamps the blood vessel and interrupts the blood flow. Then open the affected vessel, remove the calcium deposits and close it again. The blood can then flow through again. Carotid endarterectomy is the name of this method. You will usually be given a general anesthetic, more rarely a regional anesthetic. You will be able to leave the hospital again after a few days.
Carotid stenosis: treatment using hybrid surgery (TCAR)
Transcarotid stenting (TCAR for short) is a new, modern procedure that has only recently been offered at the USZ. This is a combination of carotid angioplasty with stenting and open surgery. Through a small incision in the neck (approx. 2 cm), the common carotid artery (A. carotis communis) is located and punctured. A shunt (short circuit) is then created between the carotid artery and the inguinal vein. This results in a flow reversal and the blood no longer flows up to the brain on the side to be treated, but backwards to the inguinal vein. A puncture can then be made in the carotid artery. a stent can be inserted into the constriction. The advantage is that blood clots from the aortic arch (through which the wire must be passed in the classic procedure) or from the constriction itself are caught in an intermediate filter and cannot trigger a stroke in the brain. This procedure can also be performed under local anesthesia. This procedure is offered by the Vascular Surgery Clinic.