LUIS E. SAVASTANO: Carotid artery stenosis is very common, especially in elderly patients. When patients are having symptoms for stroke and they're diagnosed with stroke, it is critical to find the root cause of the problem. Because if you cannot target your treatment, it is unlikely that you are going to provide the best benefit to patients. And the benefit is preventing future stroke.
At Mayo, we have clinics, which are multidisciplinary. And basically they have specialists, which involves neurology, stroke neurology, cardiology, vascular surgery, and neurosurgery, where we work together to understand why a patient had a stroke. Then we find the best option that we have for the patient and that is what we offer them.
For a very long time, the focus of our attention in carotid artery disease, has been on the degree of narrowing. What we have found and what we are doing with our patients now, is to look at the wall of the artery in addition to the degree of narrowing. And by looking at the wall of the artery, with basically next generation imaging tools, we can see the root cause of stroke in patients that otherwise are labeled with strokes of unknown reason. I mean, those patients where we can find the problem, we can really help them by targeting our therapy, both medically and with surgical interventions.
At Mayo we really pioneering basically, a change in the doctor. And we have basically the largest published series of patients undergoing surgery for minimal to no stenosis, and showing that we can really prevent recurrent strokes. Once the plaque becomes symptomatic or the patients having a stroke, if there is a significant narrowing, the treatment on top of the medical management includes basically repairing the artery.
And overall, there are three techniques that can be used. One, is basically removing the plaque through surgery, which is called carotid endarterectomy. The second option is to place in a stent through a catheter placed in the groin or in the wrist, that advancing towards the carotid.
And the last option, which is the most recent, is placing a stent directly from access into the carotid artery in the neck, which is called trans carotid artery revascularization. There are certain features within basically each patient that makes one option better than others. These are well-established surgeries and interventions. And of course, the more you do, the safer it is for the patients.