Stroke Prevention: New Carotid Artery Treatment | El Camino Health
>> So stenosis represents. . . if you picture a pipe that’ssupplying blood or water,stenosis is the build up thatoccurs in that artery over time,much like when you callthe plumber in to clog,declog the drains, that’sthe same sort of phenomenonthat builds up in the arteries,and a lot of people probablyare familiar with the plaquesin their coronaryarteries and their heartsand it’s the same processaffects the internalcarotid artery. Carotid endarterectomyis a surgical procedure,which is performed on patientsthat have known carotid disease,which means roughly stenosisor an occlusion of the arteriesthat supply blood to the brain. Most people believe that it’s alack of flow that causes strokesand embolic events, but in fact,it’s the plaque that buildsup in the carotid arteries muchlike in the heart and piecesof that plaque fly off and endin one of the terminal vesselsin the brain that supplyfunction and sensationto an arm or a leg per se. So the surgical procedure isactually incision about that bigon the neck, which is verywell tolerated by patients. Oftentimes we do the procedureunder a local anesthetic,but mostly I preferto put the patientsunder a general anesthetic. The procedure takes aboutan hour or hour and a halfwhere the carotidartery is dissected out,blood is temporarily shuntedaround the carotid arterywhere there is a stenosis, andthe plaque is actually scoopedout with some fancysurgical instruments. So once the plaque is removed,the source of these clotsand plaque that fly to the brainare thus removed thereby leavingthe patient withabsolutely no riskfor future embolicphenomenon from that plaque. There’s a, there’re a coupleof reasons why patients would bereferred to a vascular surgeonfor a carotid endarterectomyor carotid surveillance. Oftentimes patients are screenedin their primary carephysician’s officewith a simple test wherea stethoscope is puton the carotid arterieson both sidesand the physician mayhear what we call a bruit,which is an abnormalsensation or abnormal flowof blood that’s perceivedthrough the stethoscope. Now what that oftentimesrepresents is a stenosisthat requires further workupand oftentimes patients are thenreferred to a vascular surgeonto obtain that workup. The workup can be done usuallypainlessly which is donewith an ultrasound and thatgives us an indirect measureof how tight the stenosis is,that’s the best way to cometo a vascular surgeon’s office. Another reason whysomeone might be referredto a vascular surgeon’s officeis if the patient complainsof numbness or tinglingin an extremityor oftentimes dropping theircoffee mug for no reason,a droopy lip, slurredspeech, things like that,which we call a transientischemic attackwhich again representsthe embolic phenomenonfrom that plaque thatflies off into the brainthat controls the hand, thelip, the vision, etcetera. So that would be another reasonwhy someone would be referredto a vascular surgeon. Carotid endarterectomyis probably oneof the most common proceduresthe vascular surgeons deal with. We’ve seen patients as youngas 40 all the way to 90. Studies have clearlydemonstratedthat carotid endarterectomyis a very safe procedure,it’s a goal standard procedureagainst all other carotidinterventions which are doneand it’s been documented verywell that it’s safe in patientsup to 90 years old withexceptional results. Here at El Camino Hospitalagain we’re able to offerthrough the expertise of a groupof physicians the bestpossible operationfor any given individual basedon their clinical picture. Oftentimes when wedo hybrid procedures,which requires the expertise ofan interventional cardiologist,a vascular surgeon, and such,what we can do is aminimally invasive approachto treating the carotidendarterectomy problem. That would require threadinga catheter or wire through oneof the arteries either in thegroins or even in the armsand placing a stent whichis very unobtrusive and hasof date exceptionaloutcomes as well. Now again, we have beenat El Camino Hospitalpushing the envelope in termsof complexity of casesand tackling casesthat have been turneddown by many surgeonsand interventionalistselsewhere. El Camino Hospitalthrough the administration,through the staff andthrough the expertiseof many individualshas offered patientsand offered me the abilityto work in an environmentthat takes the expertise of notone individual but a whole teamof people includinginterventional radiologists,interventional cardiologists,and vascular surgeons. The beauty of our program isthe fact that if a patient comesin you have several sets ofeyes looking at that patient,all coming together and saying,well I think this wouldprobably be the best option,and it’s not based on,well this is my patientor this is your patient. This is based on thepatient’s presentationand their clinical scenariowhere we can say, you know what,this patient probablyneeds your input morethan it needs my input or thispatient probably needs bothof us to work togetherand collaborate on thisand we’ve done that andhave been supported in doingthat by the administrationvery welland we’ve had fantasticoutcomes, and again,I’ve been able to treat manypatients that have been turneddown for operations in thepast, but unfortunately,really need treatment andwe’ve been able to do thatand we’ve been quite successful.