Carotid stenosis is a well recognized risk factor for cerebral ischemic events such as TIA and stroke. With the evolution of endovascular technology, carotid angioplasty and stenting is emerging as a realistic, safer, and less invasive alternative for many patient populations. Recent studies suggest that a minimally invasive procedure such as carotid angioplasty and stenting may replace the current treatment, carotid endarterectomy, particularly in patients who are at high risk for conventional surgery. In a recently presented study (SAPPHIRE), stenting in high risk patients was associated with lower 30-day risk of stroke, MI, or death. Some of the criteria for high risk include severe cardiac or pulmonary disease, previous carotid endarterectomy or neck surgery and neck radiation. Other studies indicate lower morbidity and lower complication rates with stenting as compared to endarterectomy, and the use of stenting in non-high risk patients with carotid stenosis has been shown to be safe.

Dr. Srinath Kadimi is a board certified neurologist and a Fellow of the Royal College of Surgeons in Ireland. He received his fellowship training under the direction of Camilo Gomez, MD in vascular and critical care neurology at the University of Alabama, Birmingham, AL, gaining extensive experience with endovascular techniques for carotid disease during that time. Dr. Kadimi was the pioneer for the carotid angioplasty and stenting program at St. Vincent’s Medical Center in Bridgeport, CT, where he performs the majority of his procedures achieving excellent results. Dr. Kadimi also offers this procedure at Milford Hospital in Milford, CT. He is a vascular neurologist highly skilled in endovascular neuro-interventional procedures and is instrumental in bringing new stroke treatment clinical trials to this area

Dr. Kadimi is the director of vascular neurology services at Associated Neurologists of Southern Connecticut and provides a comprehensive stroke treatment program for his patients discussing the program openly with them, their families, and referring physicians.

A comprehensive stroke treatment program at Associated Neurologists of Southern Connecticut consists of the following: Consultative services:

• Consultation for cerebrovascular diseases
  
• Comprehensive screening for risk stratification for stroke and advice about risk reduction and risk modification
  
• Management of long-term effects of stroke such
  as spasticity and seizures
• Neuropsychological evaluations
  

• Carotid ultrasound
• Neuroimaging (referral to local area facilities)

• Endovascular interventions for reduction of stroke risk
• Thrombolysis for acute stroke
• Acute inpatient care in special units for management of stroke patients
• Acute inpatient rehab (interdisciplinary)
• Outpatient rehab care (interdisciplinary)
• Patient and family counseling
• Regulation / monitoring of medications to prevent stroke (e.g. Coumadin)

• Inpatient and outpatient clinical trials of promising new therapies for stroke
• Stroke education in community

63-year old presented with transient episodes of aphasia and a carotid duplex scan demonstrated high grade left internal carotid stenosis.
Long segment stenosis of left internal carotid artery.
	Wall stent in the vessel.
Post stent angiography showing the restoration of flow.
55-year old with episodes of dizziness and a neurovascular ultrasound demonstrated retrograde flow in the left vertebral artery.
High-grade subclavian stenosis with absent antegrade flow in the vertebral artery.
	Post stenting shows the excellent result with flow across the subclavian artery with antegrade flow in the vertebral artery.