Just as stents (tiny mesh tubes) are often used following coronary angioplasty (a minimally invasive procedure that uses a balloon-tipped catheter to enlarge a narrowing caused by atherosclerosis ) to keep arteries open, they can also be used to prop open carotid arteries in the neck. In fact, according to Emory researchers, stents placed in carotid arteries following angioplasty can dramatically reduce the risk of stroke in many patients - and the devices should be covered by Medicare and Medicaid payments. Emory Heart Center cardiologist Christopher Cates, MD, Director of Vascular Intervention at Emory University Hospital and Emory Crawford Long Hospital, and Anthony Gallagher, PhD, Emory University School of Medicine Associate Professor of Surgery (Research) and Research Director of the Emory Endosurgery Unit, testified yesterday before the Centers for Medicare and Medicaid Services (CMS), urging the CMS to approve reimbursements for carotid stents as well as embolic distal protection devices that use a guidewire 'basket' to capture micro-embolic material that can become dislodged during the angioplasty and stenting procedure. The CMS is the Federal agency within the U.S. Department of Health and Human Services responsible for the regulation of Medicare.
Stroke is the third leading cause of death in the U.S. and a major cause of serious, long-term disability, according to the American Heart Association.
"One of the important risk factors for stroke is carotid artery disease -- atherosclerotic plaque (fatty material) in the major vessels of the neck that supply blood to the brain," says Dr. Cates. "The use of carotid stents provides a minimally invasive alternative to carotid endarterectomy (surgical removal of arterial plaque) in high-risk patients. The efficacy of carotid stents in improving blood flow to the brain and stroke prevention in selected patients has been demonstrated repeatedly through research and clinical experience."
Carotid endarterectomy has long been considered the gold standard for treating patients with carotid arteries severely narrowed with plaque, a condition known as carotid stenosis. However, the surgery has its own risks -- serious complications, such as heart attack, stroke, and cranial nerve damage are higher in patients who undergo endarterectomy as opposed to those who receive a stent.
"For high-risk patients with significant cardiovascular disease or cardiopulmonary disorders, surgery may not be an option. However, carotid stenting is a safe and effective alternative for some patients who are at substantial risk of having a stroke but for whom medical management or surgery aren't a possibility," says Dr. Cates.
Pending what is expected to be imminent CMS approval of Medicare and Medicaid coverage of carotid stents and the emboli capture guidewire, Dr. Cates points out that Emory will be one of thirty national training sites where physicians will learn to perform the stenting procedures. Dr. Gallagher and Dr. Cates have helped design a simulator that will be used to train the doctors - much in the same way pilots learn to fly by first using flight simulators before actually operating airplanes. "It is a high tech way to speed the learning process and for doctors to gain expertise so they can perform this procedure safely. We believe this is important because stents will become an increasingly used tool in the fight against stroke," says Dr. Cates. According to the American Stroke Association, every 45 seconds, someone in America has a stroke. In all, about 700,000 Americans suffer from stroke each year.