Dr. Gaetano Pastore, M.D., F.A.C.C.

There are in excess of 700,000 strokes every year and about one-third of those can be attributed to carotid artery disease! As many as one in four American adults have some narrowing of the carotid arteries!

The carotid arteries are the two main arteries in the neck that supply the majority of the blood to the brain. These arteries are not unlike the arteries that supply blood to your heart in that they are subject to plaque and cholesterol build-up often causing severe narrowing of the artery compromising blood flow to the brain. Stroke occurs when the blood flow is critically compromised or when atherosclerotic plaque breaks loose from the artery and travels to the small vessels in the brain causing lack of oxygen to the brain with resultant damage. It is also clear that the more clogged the artery is, the more at risk you are for stroke. In fact, when the carotid arteries are in excess of 70 percent blocked, the risk of stoke increases significantly and therefore strong consideration is given to definitive treatment of this blockage to reduce the chance of stroke.

For decades, surgical removal of the plaque (known as carotid endarterectomy) has been considered the best way to remove plaque and restore normal blood flow to the brain. The operation involves creating an incision in the neck temporarily diverting blood flow in the neck while the surgeon cleans out the plaque from the diseased artery. Carotid endarterectomy has become commonplace in most major hospital centers and remains a generally safe and painless procedure often requiring an overnight stay in the hospital. It is highly effective at removing plaque from the artery and studies beyond ten years have demonstrated that the rate of recurrent blockage remains low. Despite the relative safety of this procedure, there is real concern about performing this procedure in high-risk patients. High-risk patients are defined as patients over the age of eighty years, patients who have severe heart or lung disease or those who have a history of prior neck surgery or radiation. These patients would potentially benefit from a lower-risk option for treatment. This lower-risk option involves stenting of the carotid arteries!

In late 2004, the Food and Drug Administration approved a new procedure that offers an alternative to patients considered at high risk for carotid artery surgery. These stents are much like the stents used in the arteries of the heart to unclog coronary artery blockages and restore blood flow. Placing these stents does not require neck surgery but rather the procedure is done through an IV placed in the groin area under local anesthesia and special catheters are place into the artery and advanced to the neck arteries where the stent is expanded thus opening the artery. In general, this procedure is considered to be less stressful to the patient than carotid neck surgery and therefore has evolved into a very suitable alternative for those patients who are high risk for surgical intervention. It is important to note that of all the studies done to date, the risk of death,stroke or heart attack is really no different when comparing the two procedures.

The SAPPHIRE study, the very latest comparison of stents vs. surgery in the high risk group of patients tells us that those patients undergoing the stenting procedure were just as likely to suffer a stroke or heart attack, or to die, as those who had open-neck surgery. In fact, there is some new evidence that suggests that neck arteries treated with stenting become clogged again more quickly than those cleared by surgical means…… stay tuned!

What’s the bottom line? Carotid open-neck surgery remains the treatment of choice for the majority of patients with severe carotid stenosis. In those patients that are considered high risk, we know that carotid stenting performs just as well as surgery and should be considered a safe and effective alternative procedure. Studies currently underway are focusing on the average risk patient and comparing surgery vs. stenting in this majority group of patients.

Finally, it’s important to understand that the real prevention of stroke starts with a healthy lifestyle which includes the avoidance of cigarettes and foods high in fats and cholesterol. Regular exercise has also emerged as a very important lifestyle modification that helps prevent atheroclerosis and artery plaque build-up thereby helping prevent stroke and heart attack!

Cardiology Physicians, P.A.
Abby Medical Center
One Centurian Drive
Suite 200
Newark, DE 19713
302.366.8600

1401 Foulk Road
Suite 201
Foulkstone Plaza
Wilmington, DE
302.478.5055
www.cardiocppa.com

GAETANO N. PASTORE, M.D., F.A.C.C.

Dr. Gaetano Pastore has been a member of Cardiology Physicians since July of 1998. Dr. Pastore attended Villanova University as an undergraduate. He then went to the Milton S. Hershey Medical Center of the Pennsylvania State University for his medical degree. He did his Internal Medicine residency at Hahnemann University Hospital and his cardiovascular fellowship at the Hahnemann University Hospital in Philadelphia. Dr. Pastore has contributed as a co-author on papers that have appeared in the New England Journal of Medicine and has presented at the annual scientific sessions of the American College of Cardiology.

Dr. Pastore has been recognized as an outstanding teacher/preceptor by the Christiana Care Family Practice Residency Program. He is a fellow of the American College of Cardiology and recently designated as the Governor – elect of the American College of Cardiology for the start of Delaware. Dr. Pastore has a strong commitment to clinical and consultative cardiology. Dr. Pastore has a special interest in echocardiography. This includes transthoracic, transesophageal, and stress echocardiography. He has expertise in the interpretation of nuclear imaging in cardiovascular medicine.

Dr. Pastore resides in Avondale, Pennsylvania with his wife Linda and three children Mia, Luke and Gianna. He enjoys spending his spare time with his family, generally on vacation in warm climates. Dr. Pastore enjoys tending to his 180 gallon saltwater coral reef tank and is an avid fan of thoroughbred horse racing.