Stenting Including Carotid, Renal
Specialist services available: Angiography, Angioplasty and Stenting.
- Carotid / stroke intervention
- Peripheral / below knee arterial interventions
Carotid Artery Disease and Stenting
The Team at Coastal Heart & Vascular has one of the largest experiences in Carotid Artery Stenting in Australia having performed over 250 cases. These have been fully audited by an independent Stroke Neurologist with outcomes well within accepted international complication guidelines. The team regularly lectures and performs live case demonstrations at specialist conferences and hosts workshops for international specialists wishing to learn the latest techniques and “tricks”. He is recognised by the three Specialist Colleges being the Royal Australasian Colleges of Surgeons, Radiologists, and Physicians in this area.
It must be appreciated that not all patients are suitable for Carotid Stenting and surgery can be the better and safer option on occasions. In the right hands and with careful selection of suitable patient and pathology carotid stenting is a very safe and allows rapid recovery. New technologies available in 2012 have significantly reduced the already low risk procedure. Most patients are observed overnight and discharged the next morning (compared to a 3-4 day stay for open surgery).
As has been discussed in other sections of this website, systemic arterial disease and coronary artery disease are closely associated. If you have 2 or more major blockages to the arteries in the heart you have about a 40% chance of suffering from significant systemic arterial disease such as carotid artery disease. Disease can manifest itself anywhere in the body, but more often arterial disease develops in the vessels supplying the major organs (kidneys and gut and brain) or to the lower extremities. Arterial disease that affects blood supply to vital organs such as the brain obviously requires special attention. Stroke or CerebroVascular Accident (CVA) is one of the leading causes of death and disability in our community today. Stroke can be classified into two main categories.
1) Ischaemic stroke – is the most common cause. It is due to a lack of blood (oxygen and nutrients) supply to the sensitive tissues of the brain. This can occur due to a localised occlusion of an artery from a build up of cholesterol and plaque (atherosclerosis) or from a blood clot (emboli) making its way down stream and restricting flow to an area of the brain. If the embolus is smaller it may only cause a transient loss of blood flow. This is more often called a ‘TIA’ (Transient Ischaemic Attack). At Coastal Hearts and Vascular we are qualified to fully assess and treat all major sources of stroke. Whether it be a stroke/TIA from the carotid arteries or an embolus from the heart (atrial fibrillation, PFO/ASD) we can diagnose and treat all of these conditions for you.
2) Haemorrhagic stroke – this is a stroke caused by a bleed directly from an artery within the brain. The most common cause is from an aneurysm. An aneurysm occurs when the wall of the artery becomes weakened over time and starts to expand under the normal blood pressure (much like a balloon when it is overinflated). There may be no warning of this until the artery finally gives way under pressure, thus causing a large volume of blood to fill the brain and skull and cause a change in the level of consciousness. This is a life threatening event. A haemorrhagic stroke can also occur following an accident or injury. Haemorrhagic stroke is best managed by a specialist Neurosurgeon or Neuroradiologist.
Carotid artery disease often progresses slowly. If you have known disease or at perceived high risk for carotid disease you may undergo a screening carotid duplex examination. If the disease is thought not to be severe and you are not suffering symptoms (such as TIA/stroke), then you most likely be placed on a surveillance program. In most cases that requires a check up with ultrasound every 6-12 months. As a general rule any blocked artery only becomes significantly stenosed (restricted) when the internal vessel diameter reaches 70% or less than its original size. There are however patients that develop unstable soft plaque in the arteries which contain a more liquid type fatty plaque. This type of plaque is more prone to rupture and cause a complete blockage without warning. This type of plaque may often need to be intervened on much earlier (such as at 50% diameter blockage), especially if you have had a TIA or stroke which can be linked to that area.
To read more general information about stroke, we recommend starting with the Australian stroke foundation www.strokefoundation.com.au
The treatment of peripheral vascular disease is a complex area that requires a great deal of experience and skill. Most aspects of vascular arterial disease can now be managed endovascularly (from inside the artery). Renal arterial disease is dealt with almost exclusively by this method.
The renal arteries are susceptible to formation of plaque. In a small but important number of patients suffering from uncontrolled hypertension, the cause is a stenosis of >60% in one or both of the renal arteries. If the blood flow to the kidneys is restricted by way of a stenosis, the kidneys alter certain chemicals in the body and also retain water forcing the patients blood pressure higher and higher. You may initially be referred for a renal artery duplex to assess for evidence of renal artery stenosis or to look for other signs of kidney disease.
The treatment for renal artery stenosis is ballooning with or without stenting. This is generally only performed when the stenosis in one or both of the kidneys reach higher than 70% with signs of renal impairment. As a cardiologist managing and treating hypertension day in day out, Dr Sharpe is best placed to know when and how your renal artery disease should be treated. Dr Sharpe is very experienced in the area of renal artery balloon angioplasty and stenting. Together with his extensive cardiac experience he can offer a complete assessment and treatment plan to improve your arterial health. Treatments can take only a few hours in hospital and patients can in most cases go home the same or next day.
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Coastal Heart & Vascular is a multidisciplinary team of specialists who provide
cardiology services and cardiac care.