The Bluhm Cardiovascular Institute's Center for Vascular Disease is led by surgical director William H. Pearce, MD and medical director Neil J. Stone, MD. Together these internationally recognized experts lead an outstanding team of specialists that offer multiple surgical strategies for the vascular patient.
The Center for Vascular Disease has achieved outstanding surgical outcomes as a result of a comprehensive approach to patient care. In 2006, 1,000 vascular surgery procedures were performed by the vascular surgeons at Northwestern Memorial Hospital. From 2001 to 2006, the number of endovascular procedures to treat carotid artery and aortic aneurysm disease grew significantly with a progressive decline in the number of open surgical repairs. Positive outcomes were maintained as compared to nationally available benchmarks. Benchmarking is important because it allows the Center for Vascular Disease to measure its performance compared to recognized standards of performance. Endovascular procedures are minimally invasive procedures that allow access to regions of the body through the introduction (placement) of a catheter percutaneously (through the skin) into a large blood vessel. Minimally invasive procedures allow for a faster recovery, shorter length of stay in the hospital, lower infection rates, and less bleeding and trauma.
The Center for Vascular Disease is committed to providing the best care possible to patients. In order to maintain this level of clinical excellence, physicians at the Center for Vascular Disease regularly review their clinical outcomes and based on the results, develop better ways to monitor and improve the quality of care that their patients receive. The strength of the Center for Vascular Disease is exemplified by the physicians' involvement as national leaders in several clinical trials for minimally invasive endovascular treatments of carotid artery disease and aneurysm disease of the abdominal and thoracic aorta. In addition, the Center for Vascular Disease is one of a few national carotid stent and thoracic stent graft training sites for educating physicians in these new endovascular technologies.
Carotid Endarterectomy vs Carotid Artery Stenting
Annual Procedure Volume
Carotid artery disease occurs when the major arteries in your neck become narrowed or blocked. These arteries called the right and left carotid arteries, supply 85 percent of blood flow to the brain.
The major cause of carotid artery disease is atherosclerosis or hardening of the arteries. This is a slow process in which deposits of fat, cholesterol, and calcium build up inside the artery. These deposits are called plaque. Small blood clots may form on the plaque's rough surface. These small blood clots can embolize or break loose and travel to the brain, causing a cerebrovascular accident (CVA), or travel to the heart, causing a myocardial infarction (MI) or heart attack.
Cerebrovascular accidents (CVA), or stroke as it is commonly known, is a major health concern, particularly among our increasing aged population. Annually, more than 750,000 strokes occur each year in the United States alone. Even with advances in early detection and care, this represents the third leading cause of death and leading cause of major disability in the United States.
Oftentimes, narrowing of the carotid arteries occurs without any warning until a stroke or mini-stroke, also known as a transient ischemic attack (TIA), occurs. Prevention of atherosclerosis is the primary goal in reducing the risk of stroke. However, once these critical arteries have become severely narrowed, something other than medication alone may be necessary.
Traditional treatment for severely narrowed carotid arteries has been an operation whereby the plaque build-up in the carotid artery is surgically removed. This operation, referred to as a carotid endarterectomy (CEA), has been shown to reduce the risk of subsequent strokes in individuals with both symptomatic (experiencing symptoms) and asymptomatic (not experiencing symptoms) narrowing of the carotid artery.
Despite the good results of carotid endarterectomy, advances in technology now provide a minimally invasive alternative to treat carotid artery disease using carotid angioplasty and stenting (CAS). In comparison to carotid endarterectomy, carotid stenting does not require general anesthesia or an incision in the neck.
The vascular surgeons in the Center for Vascular Disease have been actively involved in carotid endarterectomy surgery for more than 30 years, and more recently, carotid artery stenting. Since 2001, our surgeons have performed almost 200 cases of carotid artery stenting with an average annual growth rate of 42 percent in the volume of these procedures. However, our surgeons have performed over 300 cases of carotid artery stenting, when combining cases performed at the Jesse Brown VA Medical Center in the procedure volume. Most patients undergoing carotid artery stenting are enrolled in clinical research trials. Only high-risk patients are eligible for Medicare coverage for carotid artery stenting.
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Carotid Endarterectomy vs. Carotid Artery Stenting
30-Day Stroke and 30-Day Mortality/Stroke/MI Rate:
Evidence to support carotid endarterectomy is supported by several well-known prospective randomized clinical research trials conducted in the last decade. Although carotid artery stenting appears to be an attractive option in the treatment of carotid artery disease, the question remains whether the results are as good as carotid endarterectomy. The Center for Vascular Disease is committed to formulating an objective opinion about the efficacy of carotid artery stenting and thus is involved in four multi-center carotid artery stenting clinical research trials limited to 15-30 sites nationwide.
The SAPPHIRE Trial 1 (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) was a high-risk clinical research trial looking at symptomatic and asymptomatic patients with carotid artery disease. It is the current benchmark for carotid artery stenting.
The vascular surgeons at the Center for Vascular Disease have achieved outstanding results in both carotid endarterectomy and carotid artery stenting. Outstanding results are being measured by whether or not a patient experienced death, a stroke, or MI following surgery. The Center for Vascular Disease's 30-day stroke rate following carotid endarterectomy was 1.5 percent compared to the 3.3 percent in the SAPPHIRE Trial. Following carotid artery stenting, the Center for Vascular Disease had a 30-day stroke rate of 1.6 percent compared to 3.1 percent in the SAPPHIRE Trial.
The Center for Vascular Disease's overall 30-day death, stroke or MI rate following carotid endarterectomy was 2.04 percent compared to 9.9 percent in the SAPPHIRE Trial. The Center for Vascular Disease's overall 30-day mortality rate, stroke rate, and MI rate following carotid artery stenting was 3.7 percent compared to 4.4 percent in the SAPPHIRE Trial.
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Abdominal Aortic Aneurysms: Endovascular vs Open
Annual Procedure Volume
The surgical approach to repair an abdominal aortic aneurysm is either via traditional open surgery or minimally invasive techniques that involve endovascular stent grafts. Stent grafts combine flexible metal scaffolding surrounding a polyester material. They are placed inside the aneurysm -- the abnormal bulging portion of the aorta -- to contain the blood flow and prevent the aneurysm from weakening the aortic wall to the point of rupture.
In 1993, vascular surgeons in the Center for Vascular Disease performed the first endovascular repair of an abdominal aortic aneurysm in Chicago. Since 2001, the average annual growth rate in the volume of abdominal aortic aneurysms stent graft procedures at the Center for Vascular Disease was close to 20 percent.
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Abdominal Aortic Aneurysms: Endovascular vs. Open
30 Day Mortality Rate
Despite an aging population, the Center for Vascular Disease's mortality rates of both endovascular and open abdominal aortic aneurysm procedures are better than the national statistics.
The average 30-day mortality rate at the Center for Vascular Disease from 2001 - 2006 for endovascular abdominal aortic aneurysm repair was 0.7 percent. The 2003 National Hospital Discharge Survey/Nationwide Inpatient Sample (NHDS/NIS)2 rate for 30-day mortality rate for endovascular abdominal aortic aneurysm repair was 1.0 percent. The average 30-day mortality rate at the Center for Vascular Disease from 2001 - 2006 for open abdominal aortic aneurysm repair was 1.3 percent. The 2003 National Hospital Discharge Survey/Nationwide Inpatient Sample rate for 30-day mortality rate for open abdominal aortic aneurysm repair was 4.8 percent.
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Thoracoabdominal Aortic Aneurysms: Endovascular vs Open
Annual Procedure Volume
Endovascular stent grafting of thoracoabdominal aortic aneurysms now offers an alternative to the current standard of care, surgery that requires opening the chest, separating the ribs and replacing the damaged portion of the aorta with an artificial graft.
Since April of 2005, people with thoracoabdominal aortic aneurysms can now be treated with a Federal Drug Administration (FDA) approved stent graft outside of a clinical research trial. Surgeons at the Center for Vascular Disease were the first in Chicago to place a commercially available thoracic stent graft to treat a patient with a thoracoabdominal aortic aneurysm. Since 2003, the average annual growth rate in the volume of thoracoabdominal aortic aneurysm stent graft procedures at the Center for Vascular Disease was almost 30 percent.
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1. Yadav, et al. N Engl J Med. 2004; 351(15):1493-501
2. Nowygrod R., et al. Journal of Vascular Surgery. 2006; 43: 205-216
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