Stroke and Carotid Artery Disease Program

Overview: A Multidisciplinary Approach to Vascular Care

The Mass General Fireman Vascular Center is one of the only vascular centers in the country with specialists in every area of vascular disease. Our clinicians are internationally recognized as experts and innovators in the diagnosis and treatment of carotid artery disease and stroke. 

Our Stroke and Carotid Artery Disease Program brings together a team of clinicians from multiple disciplines to provide care from many perspectives, including:

• Interventional imaging
• Neurology
• Neuroradiology
• Neurointerventional imaging
• Neurosurgery
• Vascular and endovascular surgery
• Vascular medicine and interventional cardiology

We work together with the patient and referring physician to coordinate personalized treatment plans for all patients.

Diagnosis: Neurovascular Imaging Specialists

Our team of full time, board-certified imaging experts is made up of neurovascular radiologists, neurologists, vascular medicine and vascular surgery specialists who are specially trained to detect abnormalities in the vascular system and whose practice focuses specifically on vascular disease. Each specialist is trained in performance and interpretation of advanced neurovascular diagnostic tests.

Depending on the patient, we may use one or more diagnostic techniques, including:

• Duplex ultrasound
• CT scan
• Magnetic resonance angiography (MRA)

These tests are also available at our convenient Waltham location.

Stroke Prevention and Treatment

Preventing Stroke by Treating Carotid Stenosis

Our primary treatment goal is to prevent future stroke in patients through a combination of lifestyle changes, medical management and other interventions. Our neurovascular specialists guide patients through smoking cessation programs and work with cardiologists in the Corrigan Minehan Heart Center to treat heart disease. We encourage our patients to make the following lifestyle changes, if necessary:

• Avoid smoking
• Control blood pressure
• Maintain normal blood sugar levels for those with diabetes
• Eat a diet low in cholesterol and saturated fats
• Exercise regularly
• Maintain a healthy weight
• Take platelet-blocking medications, such as aspirin

If our physicians decide to use an interventional approach, we offer the following procedures:

• Carotid endarterectomy: This surgical procedure removes plaque blocking or narrowing a patient’s carotid artery and has been shown to be an effective and safe way to prevent stroke caused by carotid stenosis
• Angioplasty and stenting: This newer, minimally invasive technique involves threading a balloon-tipped catheter through the affected artery to expand it. A stent may be inserted to keep the artery open. The physicians at the Stroke and Carotid Artery Disease Program are leaders in the use of angioplasty and stenting for carotid stenosis and are involved in national trials evaluating this technology

A State-Designated Primary Stroke Center

In 2006 Massachusetts General Hospital physicians treated more stroke patients with an in-hospital stay than any other hospital in Massachusetts. A state-designated primary stroke center, Mass General provides emergency diagnostic and therapeutic services 24 hours a day, seven days a week to patients with symptoms of acute stroke. Our Stroke Service focuses on the prevention, diagnosis and treatment of all stages of stroke.

• These neurovascular specialists offer the following services to stroke patients:
• Preventive care and medical management of stroke risk factors
• Clot-dissolving medications (thrombolysis) and devices (thrombectomy)
• Surgical clipping or endovascular coiling of ruptured aneurysms (a cause of hemorrhagic stroke)
• Telestroke, which involves the use of videoconferencing and image sharing technology to diagnose and recommend treatments for patients at 12 community hospitals

Treatments and Care of Carotid Artery Disease and Stroke

Access to Promising New Treatments

The Fireman Vascular Center participates in most major clinical studies evaluating new technologies and medications to treat carotid stenosis. This allows us to bring our patients promising new treatments as quickly as possible. Some of these studies include:

• ACT 1: This innovative trial compares carotid endarterectomy with stenting in patients who have carotid stenosis but no symptoms. Dr. Rosenfield is the national principal investigator of the ACT 1 trial. Read more about the results of this study.
• CREST: This trial looked at the efficacy of carotid endarterectomy versus stenting in patients with symptomatic carotid stenosis, and found that these two medical procedures are both equally safe and effective. These findings give physicians more options in tailoring treatments for their patients at risk for stroke.

• Aphasia Research Treatment for Bilingual Stroke Survivors

• Do you have upper-extremity weakness due to a stroke?

• Stroke Recovery and Fatigue

• Study Examining Cerebral Amyloid Angiopathy and Memory Loss

• Wrist-worn sensors for home-based arm rehabilitation in stroke survivors.

Patients interested in participating in clinical trials should contact their provider to learn more.

Learn more about our clinical research >

One Call Coordinates Care

Our access coordinator is available Monday through Friday from 8:00 am to 5:00 pm to take relevant information about your condition and symptoms and to make a timely appointment with the most appropriate specialist. Call 877-644-8346 or request an appointment online.

We strive to see patients as soon as possible and assign every patient one clinician to organize care between members of our multidisciplinary team. From diagnosis to treatment and follow-up, this physician guides patients through the treatment process.

Tracking Outcomes to Improve Care

The Fireman Vascular Center has taken the unprecedented step of independently following the outcomes of patients who have undergone procedures for carotid artery disease and stroke. While patients are in our care, we carefully document how they respond to treatment using the National Institutes of Health Stroke Scale.

We are one of the only hospitals in the nation to perform the Stroke Scale on patients scheduled for either carotid endarterectomy or carotid artery stent before and following their treatment. These tracking systems ensure we deliver quality care and inform the public about our success rates with unprecedented accuracy and objectivity.

Patients and family members can feel confident that our team is always striving to provide the best possible outcome.

Conditions We Treat

The care team at the Fireman Vascular Center encourages all patients and family members to learn more about conditions and diseases that affect the cardiovascular system. The links below provide more information about vascular conditions and diseases that might be treated within this program.

• Carotid Artery Disease: also called carotid artery stenosis, carotid artery disease occurs when the carotid arteries, the main blood vessels that carry oxygenated blood to the brain, become narrowed.
• Stroke: also called brain attack, occurs when blood flow to the brain is disrupted.