If the stenosis is more than 60%, the risk of a stroke increases, so that treatment consisting solely of taking tablets is usually no longer sufficient.
At the USZ, we offer you three options for eliminating the bottleneck:
- Carotid angioplasty with stent: Through a small stitch in the groin, we can advance a stent (small metal wire tube) with a wire through your other arteries into the carotid artery. We then expand this stent and flatten the constriction between the vessel wall and the wire tube. However, because the stent is not tight, but looks like a small wire mesh, in the worst case small particles (calcium or blood clots) can become detached, leading to a stroke. We therefore insert a small filter into the artery before the stent is expanded. This filter can catch the particles. This prevents them from reaching the head and triggering a stroke. Once the stent has expanded, we remove the small filter again. This procedure is called stent angioplasty.
- Carotid stenosis – treatment using open surgery: During carotid endarterectomy, we completely remove the vascular calcification from your carotid artery. To do this, we make an incision in the neck and locate your carotid artery. We then clamp the artery for a short period and cut it open to carefully remove the calcium or blood clot from the vessel wall. We take particular care to ensure that all material is removed from the carotid artery. Unlike with a stent, the calcium or clot is completely removed and not pressed against the wall. This reduces your risk of having a stroke after the operation. Once we have removed the limescale, we carefully rinse the vein and then close it with a patch made of bovine pericardium. This material is very smooth and similar to our vessel wall. We sew the patch in by hand so that it fits your vein perfectly. We then release the blood supply to your head and sew the incision closed. Only a thin scar remains on her neck. To avoid having to remove stitches, we use a thread for the skin suture that dissolves by itself after a few weeks.
- Carotid artery stenosis – treatment using hybrid surgery (TCAR): We also offer a new procedure for the treatment of stenosis of the carotid artery. With transcarotid stenting (TCAR), we combine stenting with a small incision in the neck. We look for the lower part of your carotid artery and insert a small tube there and in the inguinal vein. We then suck through a machine on the tube at the neck and divert your blood from the neck into the groin. This causes the blood to flow from the head into the leg. We then place the stent in the constriction. Because the blood now flows from the head into the leg, small particles that may have become detached are passed through the machine and filtered out. The blood then enters your inguinal vein. This trick significantly reduces the risk of a stroke, which can be triggered by such particles.
