Stents emerge as alternative to surgery for stemming stroke risk.

Byline: John Fauber

MILWAUKEE _ On three separate occasions over a 19-month period, doctors examined George Downing's carotid artery and didn't like what they saw.

The vessel, one of the two main arteries supplying blood to the head and brain, had become severely blocked, putting Downing, 78, at high risk for a stroke that could kill or disable him.

The first two fixes, which didn't last long, were done using a procedure known as carotid endarterectomy, in which the artery is surgically opened so that plaque and fatty material can be removed from the artery wall.

Months after the second surgery, Downing would return to the hospital for a third, and unconventional, repair.

Doctors have been doing endarterectomies since the 1950s, although there had been few large clinical trials showing when they were appropriate. It's only been in the last 10 years that several large studies have shown that the procedure can substantially reduce strokes in certain patients.

Unfortunately, Downing wasn't one of them.

He had his first endarterectomy in November 2001 after doctors found that his carotid artery was 90 percent blocked. He spent several days at St. Luke's Medical Center recovering from the surgery, temporarily lost his voice and developed a cough.

Then, four months after the surgery, he suffered a small stroke.

The artery had …