CONTACT: Gregory McGarry or Richard Puff Albany Medical Center Albany, NY 518-262-3421 [email protected]
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ALBANY, N.Y., April 21, 1998 -- A rarely used surgical technique to clear plaque from the artery leading to the brain is not only three times faster than the conventional procedure, but results in a 10-fold decrease in a reclogging of the artery, according to a study by Albany Medical Center physicians.
Dhiraj Shah, M.D., professor of surgery and director of the Center for Vascular Diseases, and R. Clement Darling III, M.D., associate professor of surgery and head of the division of vascular surgery, reported the results of the Medical Center's study recently at the annual meeting of the prestigious American Surgical Association in Palm Beach, Fla.
In results from more than 2,200 procedures performed over five years, patients have shown much less risk for stroke in the short term and for recurrence of the blockage over time when the eversion carotid endarterectomy technique is used, Dr. Darling said.
Surgeons intervene to clean out these clogged vessels to prevent stroke caused by loss of blood supply to the brain.
The eversion endarterectomy technique involves severing the interior carotid artery, which carries blood to the brain, at its widest point. That's right at the bulbous joint where it branches off the main carotid artery as one of two smaller arteries. The other branch carries blood to the face.
The surgeons then evert, or peel back, the interior carotid artery all the way up to the end of the cylindrical plug of plaque clogging the passage, revealing the interior wall of the vessel. They remove the plaque, fold the artery down and sew it back together at its largest part.
"Basically, you turn the whole artery inside out and you can visualize the entire stenosis, or blockage," said Dr. Shah. "This way the chance of restenosis is significantly reduced about 10-fold."
More specifically, the incidence of reclogging the artery to the brain following surgery is only 3 in 1,000 cases with the eversion technique. The rate is 3 in 100 cases when conventional techniques are used.
Conventionally in this country, surgeons have used a long incision in the side of the interior carotid artery to remove plaque. Dr. Shah said the longitudinal incision has a number of disadvantages. For one thing, it makes it more difficult to see the end of the blockage and examine the interior of the vessel.
More significantly, the sutures that repair the long incision at the narrow end well up into the artery leading to the brain, cause narrowing of the vessel. That promotes restenosis, or a reblockage. With the eversion technique, surgeons do not have to place any sutures up in the narrow part of the interior carotid artery; the incision and repair are done at the wider area at the junction of the branches.
Other advantages include time factors: The eversion technique can be performed in only one hour, as opposed to three hours for a conventional endarterectomy. Surgeons stop the blood flow to the brain for only 14 minutes to perform the eversion technique, as opposed to 40 minutes the other way.
Carotid artery eversion endarterectomy is performed 700 times a year at Albany Med. It is used regularly at only one other medical center in the United States. The technique was first invented in 1959, refined and developed in Europe, and first performed at Albany Med in 1993.
Dr. Darling said vascular surgeons have shown great interest in learning the technique, and Albany Med surgeons have presented their work at numerous national surgical meetings recently.
"This is a relatively new technique, people don't like to change what they've been doing for years, and there's a bit of a learning curve involved," he said. But, he said, it's inevitable that this will soon be the preferred method. "The eversion technique puts the brain at less risk for immediate complications and for long-term problems."
Albany Medical Center, the only academic health sciences center in the 25-counties of northeastern New York and western New England, includes the 651-bed Albany Medical Center Hospital, the Albany Medical College, the Albany Medical Center Faculty Group Practice and the Albany Medical Center Foundation, Inc.
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For further information or to arrange interviews with Dr. Shah, Dr. Darling and their patients, please call Gregory McGarry, director of public relations, or Richard Puff, assistant director of public relations, at (518) 262-3421.
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