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Medical Edge Newspaper Column from Mayo Clinic
ALTERNATIVE TO MAJOR SURGERY AVAILABLE FOR CLOGGED ARTERIES
DEAR MAYO CLINIC: I heard they can use a balloon for clogged carotid
arteries like they do for heart procedures. My sister has been diagnosed
with transient ischemic attacks, and now they want to operate on her.
The balloon thing seems easier on your health. Is that available now?
— Austin, Texas
ANSWER: The procedure you describe is called carotid angioplasty with
stent placement, or CAS. It is an emerging alternative to the successful,
traditional surgery, carotid endarterectomy.
During carotid endarterectomy, surgeons remove plaque from inside the
affected blood vessel to reduce the future risk of stroke. The operation
is considered major surgery and requires that the patient undergo general
anesthesia. CAS differs in that the patient is awake — but sedated — while
a small tube with an attached balloon is threaded into the artery. When
the balloon is inflated, it opens the blockage. To keep the artery open,
doctors place a stent — a scaffolding-like device — that secures the plaque
to the sides of the vessel wall so it doesn’t become partially blocked
again.
The National Institutes of Health is currently coordinating a large clinical
trial known as CREST (Carotid Revascularization Endarterectomy vs. Stent
Trial) to determine the long-term effectiveness of CAS. Results are not
yet available. However, because many major medical centers, including
Mayo Clinic, are participating in this trial, you should be able to find
a medical center near you that either does the CAS procedure or is accepting
enrollees into the trial.
Because early measures of CAS success were so similar to the outcomes
for standard surgery, its use has been cautiously and carefully expanded
in recent years. The goal of CREST is to conclusively determine its long-term
benefit.
Robert Brown, M.D. Neurology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment
of Carotid Artery Disease
Appointment
Information
Information
on Carotid Angioplasty
DEAR MAYO CLINIC: My daycare provider just told me her doctors
think her child has juvenile dermatomyositis, and went on and on as if
I knew what she was talking about. I don’t. What is it, and should I be
concerned that my child spends eight hours a day in her apartment? Is
it contagious, and should I have my child checked for it? What causes
it? — New York
ANSWER: Juvenile dermatomyositis (der-mat-o-my-o-SITE-us), or JDM,
is a rare, muscle-damaging condition that affects about five out of every
1 million U.S. children. It’s not contagious.
JDM is characterized by inflammation of the blood vessels in the muscles
and skin, which causes muscle damage and a rash. Symptoms appear gradually
and include muscle pain, tenderness and weakness; difficulty swallowing;
weight loss; irritability; fatigue; fever; and rash affecting the eyelids,
finger joints, knuckles, elbows, ankles or knees.
JDM is an autoimmune disease — a condition in which the body’s immune
system attacks itself. Although we don’t fully understand what starts
this misguided assault, we have clues. In the largest study of its kind,
our research team examined 72 JDM patients who were an average age of
10 years old. Our data suggest one mechanism that drives JDM is the presence
of “chimeric” cells — cells that originate in the mother and are passed
on to the fetus, persisting in the child’s body after birth. We believe
these chimeric cells may provoke an immune response that leads to JDM.
While there is no cure for JDM, there are treatment options: medications
to reduce inflammation and skin rashes; physical and occupational therapy
to improve muscle function; and nutritional support.
Ann Reed, M.D., Pediatric and Adolescent Medicine, Mayo Clinic, Rochester,
Minn.
Additional Resources:
Treatment
of Dermatomyositis in Children
Appointment
Information
More
Information on Dermatomyositis
READERS: If your doctor prescribes a medication, but says it’s an
off-label use, should you be concerned?
“Off-label use” means that a drug is being used for a purpose not listed
on the product’s label. It could be Botox injections for migraines, or
Prozac, an antidepressant, for hot flashes.
The Mayo Clinic Health Letter says taking medications off-label
is common, acceptable and, for some disorders, it may be the standard
of care. Over time, doctors' experience with a drug leads to new applications.
Researchers and doctors share information about off-label use in medical
publications. The Food and Drug Administration allows off-label use for
drugs it has already approved.
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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