Clearing the carotid

patient bob rising his bike

It was Bob’s pastor who first spotted his symptoms.

“He noticed that I was struggling with my speech,” Bob said. “It was an odd feeling—I knew what I wanted to say, but I just couldn’t form the words and get them out. It was quite concerning.” Bob followed up by making an appointment with his cardiologist, Dr. Timothy Logan at McLaren Macomb.

After some diagnostic testing, it was determined that one of Bob’s carotid arteries—the blood vessels in the neck that carry blood to the brain, neck and face—was significantly blocked.

Carotid stenosis, as his underlying condition is called, can cause symptoms of confusion and the inability to speak, among others.

But Bob was not too surprised.

He had multiple risk factors—family history, high blood pressure and high cholesterol. Dr. Logan would continue to regularly monitor Bob’s condition.

The vital carotid artery is the major blood vessel carrying oxygenated blood to the brain. Plaque buildup causing the artery to narrow—stenosis—decreases the amount of blood reaching the brain.

Putting the patient at a more immediate risk, there’s a high danger that plaque will produce a clot that breaks free and travels through the blood vessel into the brain, causing a stroke.

As his stenosis worsened, to relieve his symptoms while also significantly reducing his risk of stroke, Bob’s carotid artery would have to be stented—fitted with a tubular support to relieve the obstruction. He was referred to Dr. Joseph Cuppari, a vascular surgeon at McLaren Macomb.

“When stenting a narrowed carotid artery, there’s still the risk of plaque breaking free and heading to the brain,” Dr. Cuppari said. “It’s vital for us to protect against this occurrence.”

To relieve Bob’s specific condition, Dr. Cuppari decided he would use advanced surgical technology—a device and procedure with the capability to reverse blood flow away from the brain while a stent is placed.

Protecting the brain

Dr. Cuppari is one of only a handful of vascular surgeons in the state with the training and certification to perform TCAR (TransCarotid Artery Revascularization), the minimally invasive procedure that allows surgeons to clear the blockage of the carotid artery while protecting the brain from rogue, stroke-causing blood clots.

TCAR also allows surgeons to collect and remove plaque debris.

“This is a big step for stroke management in that the up-front treatment of carotid artery disease will significantly decrease a patient’s risk for stroke,” Dr. Cuppari said. “While traditional, open approaches still have their merit, in Bob’s case this minimally invasive procedure would provide additional safeguards against a stroke by reversing blood flow and further protecting the brain, ultimately leaving the patient with an enhanced clinical outcome and improved quality of life.”

In addition to high cholesterol and blood pressure, smoking is a major risk factor for carotid stenosis.

Not all patients exhibit symptoms, but those who do can experience those that mirror a stroke, such as numbness in the face, temporary loss of vision, sudden, severe headaches and speech loss, as Bob experienced.

Quality of life

“I had all the confidence in the world in this procedure,” Bob said. “I trusted that Dr. Cuppari knows what he’s doing. I wasn’t concerned about it. He was a great surgeon.”

After the procedure, the artery that was critically blocked was now back to flowing at a healthy capacity. Gone were the alarming symptoms. After a single night’s stay for observation, Bob was back home.

“I haven’t noticed any speech symptoms, or other symptoms, since,” he said.

Said Dr. Cuppari, “This procedure, in its very unique and innovative way, gives our patients a very lasting impact.

Not only can it alleviate their current symptoms, it also significantly reduces the risk of them having a life-threatening stroke.

“This gives them greater peace of mind and a revamped quality of life.”