Extracranial Carotid Atherosclerosis
Extracranial Carotid Atherosclerosis.
Approximately 30% of Strokes are Caused by Extracranial Carotid Atherosclerosis
Stroke is the third leading cause of death in the US. Every year over 500,000 new strokes are responsible for approximately
200,000 deaths in our country. Stroke survivors, currently around 4.4 million, create a significant impact in the resources
of an already ailing Medicare system.
As with atherosclerosis in general, Carotid atherosclerosis is a chronic process that develops over many years and thrives on several well recognized risk factors such as diabetes, tobacco use, hypertension, abnormal lipid profiles and some rare genetic syndromes.
There is good news: Most risk factors for Atherosclerosis can be modified or controlled. Extracranial Carotid Atherosclerosis can be easily detected by Duplex Ultrasound at an accredited Vascular Laboratory. Carotid stenosis caused by Atherosclerosis can be repaired by our experienced Miami Vascular Specialists team.
Options for Carotid Therapy and the CREST trial
Carotid therapy starts at the primary care physicians' office. Diabetes control, smoking cessation, BP control, lipid control, weight loss and exercise are important steps for the prevention of significant carotid stenosis.
Most experts agree that once a patient develops asymptomatic stenosis over 60% or any stenosis accompanied by hemispheric neurologic symptoms, they should be referred to a specialist for consultation. Options for therapy may include more aggressive statin, and antiplatelet therapy, Carotid endarterectomy (CEA) and Carotid PTA and stenting (CAS).
The CREST trial is a pivotal National trial involving thousands of patients with the goal to compare two strategies for revascularization: Carotid endarterectomy and carotid stenting. CREST had strict inclusion criteria for physician investigators and required an independent review of the physician's past results and track-record. Extracranial Carotid Atherosclerosis
BCVI was the only CREST participating Center in South Florida and Miami Vascular Specialists proudly represented BCVI in this crucial National trial.
Our "Team Concept"
The CREST trial as well as several other major European trials showed that some patients fare better with Stenting while others have better outcomes with Surgery. The outcome mainly depends on patient's age, anatomy, plaque morphology and Cardiac risk.
Miami Vascular Specialists include internationally known Interventional Radiologists and Vascular Surgeons with proven results and track-records. Partners from both specialties work closely in the evaluation of each patient and all decisions are peer-reviewed. The welfare of every patient along with optimal outcomes is our mission. Incredibly, CREST showed the lowest rate of major stroke in any revascularization trial to date: less than 1% in both CEA and CAS, highlighting the outstanding outcomes that can be achieved in highly trained hands.
Recently, a new horizon has opened in the field of Intracranial Carotid Intervention. Miami Vascular Specialists proudly include a very talented and active Neuroradiology team among our partners. Intracranial intervention is now possible in the very small branches of the Internal Carotid artery and the Basilar system inside the brain.
BCVI Cardiologists and Cardiac Surgeons are crucial in the evaluation and treatment of coronary artery atherosclerosis which is so frequent in our Carotid patients. They optimize pressure and lipid control. Our Anesthesiology department with subspecialty trained staff is invaluable in the effort to achieve optimal outcomes.
This team and collaboration concept which has flourished under the umbrella of BCVI and Baptist Health has attracted the CREST trial investigators and continues to attract numerous trials testing the cutting edge of Vascular Technology which the Miami Vascular Specialists are proud to offer.