A pinky-sized mesh tube made of a metal alloy gives doctors a new way to treat high-risk patients with carotid artery disease.

People with the disease have plaque lining the carotid arteries in the neck. High-risk patients have 70 percent or more of the artery blocked by plaque, as well as other factors that place them at risk for stroke.

St. Alexius Medical Center recently completed its first two carotid stentings. The procedure was June 15. Medcenter One is in the final phase of implementation for doing a carotid stent and plans to do its first surgery soon, Medcenter One spokeswoman Kris Magstadt said.

The stent procedure at St. Alexius was performed by Dr. Jose Wiley, an interventional cardiologist. He was involved in a study of patients whose arteries narrowed again with plaque.

Not all patients who have carotid artery disease, which is a type of peripheral artery disease, are candidates for the stent.

"The number treated surgically is much higher than stenting because of the guidelines," Wiley said.

The traditional method for treating carotid artery disease is with surgery. An incision is made in the neck, the artery is cut and plaque is scraped from the artery wall.

The stent works like a scaffold to keep the artery open, Wiley said. The stent aims to decrease the number of embolic strokes, which are caused by clots. This type of stroke accounts for 25 percent to 30 percent of the 700,000 strokes in the United States annually, Wiley said.

Before the stent in inserted in the internal carotid artery, a catheter is inserted with a device to remove the plaque, which is called embolic material. It is caught in a net-like device that allows blood to flow through but keeps the dislodged plaque from moving through the circulatory system and possibly causing a clot.

Next, the doctor inserts a balloon to expand the artery and then inserts the stent.

A medical trial is looking at the effectiveness of stents on low-risk patients. Earlier trials showed in high-risk patients it reduced the risk of stroke compared to surgery patients, and it worked on patients who had the surgery previously but the plaque lined the arteries again.

Inserting the stent in a nonsurgical procedure requires less time in the hospital. The less time in the hospital could make the procedure cost less than the surgery, Wiley said.

People who have this procedure are given a stroke assessment before and after it is done.

"That's important, it's a good way to track neurological complications," Wiley said.

A patient meets with the doctor for follow-up at one month, three months, six months, one year and every year after.

They are given a carotid ultrasound as part of the assessment. The hospital tracks its patients on the National Cardiovascular Data Registry CARE Registry.

People who have this procedure are put on anti-platelet drugs before and after the procedure. This type of drug keeps blood clots from forming.

If a person is on high blood pressure medication, they do not take it the day of the surgery. The surgery itself does not require lifestyle changes to diet or physical activity, but treatment for the disease could.

Doctors who perform the procedure must meet specific criteria. This includes extensive, high-level experience with stents, performing diagnostic procedures and working with catheters.

(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@;bismarcktribune.com.)