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Medical Edge Newspaper Column from Mayo Clinic

COMPARING TREATMENTS FOR BLOCKED CAROTID ARTERY

DEAR MAYO CLINIC: I have a blockage to my right internal carotid artery. The doctor has recommended either a carotid endarterectomy or angioplasty with stent. I would like additional information and a comparison of the two procedures. I would also like to know the life expectancy of the stent. — Reno, Nev.

ANSWER: Both procedures have the same objective — to reduce the blockage in your internal carotid artery and reduce your risk of stroke.

Depending on your situation, either could be appropriate. However, angioplasty is a newer procedure for blockages in the carotid artery. Research is under way to compare these two approaches, but it’s not yet complete.

Here’s some background on the procedures and a look at their differences:

Carotid endarterectomy: In this surgical procedure, an incision is made in your neck to expose the carotid artery. The surgeon opens the artery and removes the plaque. Carotid endarterectomy is the standard surgical treatment for blocked carotid arteries, the main arteries that supply blood to the brain.

Angioplasty: In this procedure, a balloon-tipped catheter is maneuvered to the blockage in the carotid artery. The balloon is inflated, pushing the plaque back against the artery walls. A stent, a metal wire-mesh tube, then is placed to keep the plaque against the artery wall.

The U.S. Food and Drug Administration has not approved angioplasty for patients who have no symptoms from their carotid artery blockages. For high-risk patients who have had warning signs of stokes, such as a transient ischemic attack (sometimes called a ministroke), angioplasty is an FDA-approved treatment.

Initial research results for angioplasty look quite good. It appears that angioplasty poses about the same risk to patients as carotid endarterectomy. Both also seem to offer a similar decrease in the future risk of stroke.

Until the research is complete, we won’t know the long-term results of placing a stent in the carotid artery. I suggest you consult with a physician at a comprehensive health-care center that has a broad program for stroke prevention and treatment. Most offer both procedures, and your physician can help you make the best choice.

— William Stone, M.D., Vascular Surgery, Mayo Clinic, Scottsdale, Ariz.

Additional Resources:
Blocked Carotid Artery
Appointment Information
More Information on Heart Disease

READERS: What’s the best strategy to soothe sore, aching muscles, heat or cold?

Cold first, advises Mayo Clinic Health Letter. Later, heat can help.

Cold first: To relieve pain associated with sprains and strains, it’s usually best to first apply a cold compress for about 20 minutes at a time every four to six hours over the first few days. Cold reduces swelling and inflammation and relieves pain. For a cold compress, you can use a cold pack, a plastic bag filled with ice or a bag of frozen vegetables; wrap it in a dry cloth or towel to help prevent frostbite.

Then heat: Start using heat after pain and swelling have decreased, usually two to three days after the injury. Heat relaxes tightened and sore muscles and reduces pain. Heat is usually better than cold for chronic pain — such as from arthritis — or for muscle relaxation.

Apply heat to the injured areas for 20 minutes up to three times a day. Traditional methods include using a heat lamp, hot water bottle or warm compress, or taking a warm bath or hot shower.

A new option for heat therapy involves single-use wraps or patches that adhere to your skin or clothing near the sore spots. Chemicals in these wraps or patches warm up as they’re exposed to air when you open the package. Because they provide a lower level of therapeutic heat, they are safe for extended use — eight hours or more. (But always follow the manufacturer’s instructions.)
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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.