Resource: Spring 2004 - Baptist Health South Florida

Baptist Cardiac & Vascula
AMAZING! That’s the reaction I had when I read writer Sandy Baksys’ stories about new ways to prevent
and treat strokes, advances in the treatment of aneurysms, as well as the latest information on how heart
disease affects women and people with diabetes. Baptist Cardiac & Vascular Institute (formerly Miami
Cardiac & Vascular Insitute) has pioneered new treatments in cardiovascular disease since it opened in 1987.
But equally important is its mission of prevention, education and clinical research. We hope you’ll find these
stories informative...and for some of our readers, even life-saving.
—-The Editor
Carotid stents prevent strokes
William Cohen, 61, was on the road to a stroke when
doctors at Baptist Hospital opened a blocked artery
in his neck with angioplasty and a stent instead of
surgery.
“I was really grateful that they caught this in time, that I didn’t
have a stroke and I didn’t have surgery, either,” said Mr. Cohen,
who owns a small freight forwarding company in Coral Springs.
When Mr. Cohen was diagnosed with a 92 percent blockage
in one of the carotid arteries in his neck, his doctor recommended
a surgery called endarterectomy. Surgery prevents
strokes by removing plaque in the artery that can shed
clots and other fatty particles directly into the brain.
But Mr. Cohen wanted an alternative. He sought an expert
opinion at Baptist Cardiac & Vascular Institute, where he
entered a clinical research trial of carotid angioplasty and stenting.
Both procedures have been used for years in the heart.
But they pose special challenges in the neck because physicians
are working so close to the brain.
For example, even before Mr. Cohen’s angioplasty could
begin, a tiny, removable umbrella had to be positioned inside
his carotid artery, downstream from his blockage, to trap any
fatty debris that could come loose and cause a stroke.
And, unlike heart stents implanted deep within the body,
carotid stents need to be flexible and uncrushable as the neck
bends and twists and is touched and pressed. Today’s carotid
stents are made of a special material called nitinol, which holds
its shape at body temperature.
before after
A dramatic difference can be seen after a blocked carotid
artery (left) is propped open with a stent (right) to restore
blood flow to the brain.
6 RESOURCE
A tiny, removable umbrella is placed inside the carotid
artery to catch any debris that could break loose and cause
a stroke.
The first such stent is expected to be approved by the FDA
this year. Soon afterward, the Institute will become a training
center for other physicians who want to learn how to use it.
That’s because Institute physicians have played a leading,
national role in the development and testing of carotid stents.
Barry Katzen, M.D., the Institute’s founder and medical director,
helped organize one of the first national studies demonstrating
that carotid stenting is equal to surgery in preventing
strokes, with fewer serious complications.
Until stents were developed to open carotid arteries, surgery
was the only preventive treatment. “Surgery has
long been the gold standard for preventing stroke, and
we expect it to continue to be an important option for patients
with advanced carotid disease,” said Jose Alvarez, M.D., the
Institute’s chief of vascular surgery.
For those who choose surgery, the Institute’s outcomes are
outstanding: serious complications after carotid surgery are 50
percent lower than American Heart Association guidelines.
Now the Institute is participating in clinical research sponsored
by the National Institutes of Health. “What’s exciting
about this new research is that it enlists hundreds of the most
skilled physicians across the country,” Dr. Katzen said. “We
already know that stenting is less invasive than surgery. Now
we will learn which procedure actually protects better against
strokes in patients with advanced carotid disease.” ♥