Stroke Prevention: New Carotid Artery Treatment | El Camino Health

>> So stenosis represents. . . if you picture a pipe that’s
supplying blood or water,stenosis is the build up that
occurs in that artery over time,much like when you call
the plumber in to clog,declog the drains, that’s
the same sort of phenomenonthat builds up in the arteries,and a lot of people probably
are familiar with the plaquesin their coronary
arteries and their heartsand it’s the same process
affects the internalcarotid artery. Carotid endarterectomy
is a surgical procedure,which is performed on patients
that have known carotid disease,which means roughly stenosis
or an occlusion of the arteriesthat supply blood to the brain. Most people believe that it’s a
lack of flow that causes strokesand embolic events, but in fact,
it’s the plaque that buildsup in the carotid arteries much
like in the heart and piecesof that plaque fly off and end
in one of the terminal vesselsin the brain that supply
function and sensationto an arm or a leg per se. So the surgical procedure is
actually incision about that bigon the neck, which is very
well tolerated by patients. Oftentimes we do the procedure
under a local anesthetic,but mostly I prefer
to put the patientsunder a general anesthetic. The procedure takes about
an hour or hour and a halfwhere the carotid
artery is dissected out,blood is temporarily shunted
around the carotid arterywhere there is a stenosis, and
the plaque is actually scoopedout with some fancy
surgical instruments. So once the plaque is removed,
the source of these clotsand plaque that fly to the brain
are thus removed thereby leavingthe patient with
absolutely no riskfor future embolic
phenomenon from that plaque. There’s a, there’re a coupleof reasons why patients would be
referred to a vascular surgeonfor a carotid endarterectomy
or carotid surveillance. Oftentimes patients are screenedin their primary care
physician’s officewith a simple test where
a stethoscope is puton the carotid arteries
on both sidesand the physician may
hear what we call a bruit,which is an abnormal
sensation or abnormal flowof blood that’s perceived
through the stethoscope. Now what that oftentimes
represents is a stenosisthat requires further workupand oftentimes patients are then
referred to a vascular surgeonto obtain that workup. The workup can be done usually
painlessly which is donewith an ultrasound and that
gives us an indirect measureof how tight the stenosis is,
that’s the best way to cometo a vascular surgeon’s office. Another reason why
someone might be referredto a vascular surgeon’s office
is if the patient complainsof numbness or tingling
in an extremityor oftentimes dropping their
coffee mug for no reason,a droopy lip, slurred
speech, things like that,which we call a transient
ischemic attackwhich again represents
the embolic phenomenonfrom that plaque that
flies off into the brainthat controls the hand, the
lip, the vision, etcetera. So that would be another reason
why someone would be referredto a vascular surgeon. Carotid endarterectomy
is probably oneof the most common procedures
the vascular surgeons deal with. We’ve seen patients as young
as 40 all the way to 90. Studies have clearly
demonstratedthat carotid endarterectomy
is a very safe procedure,it’s a goal standard procedureagainst all other carotid
interventions which are doneand it’s been documented very
well that it’s safe in patientsup to 90 years old with
exceptional results. Here at El Camino Hospital
again we’re able to offerthrough the expertise of a groupof physicians the best
possible operationfor any given individual based
on their clinical picture. Oftentimes when we
do hybrid procedures,which requires the expertise of
an interventional cardiologist,a vascular surgeon, and such,what we can do is a
minimally invasive approachto treating the carotid
endarterectomy problem. That would require threading
a catheter or wire through oneof the arteries either in the
groins or even in the armsand placing a stent which
is very unobtrusive and hasof date exceptional
outcomes as well. Now again, we have beenat El Camino Hospital
pushing the envelope in termsof complexity of cases
and tackling casesthat have been turned
down by many surgeonsand interventionalists
elsewhere. El Camino Hospital
through the administration,through the staff and
through the expertiseof many individuals
has offered patientsand offered me the ability
to work in an environmentthat takes the expertise of not
one individual but a whole teamof people including
interventional radiologists,interventional cardiologists,
and vascular surgeons. The beauty of our program is
the fact that if a patient comesin you have several sets of
eyes looking at that patient,all coming together and saying,well I think this would
probably be the best option,and it’s not based on,
well this is my patientor this is your patient. This is based on the
patient’s presentationand their clinical scenario
where we can say, you know what,this patient probably
needs your input morethan it needs my input or this
patient probably needs bothof us to work together
and collaborate on thisand we’ve done that and
have been supported in doingthat by the administration
very welland we’ve had fantastic
outcomes, and again,I’ve been able to treat many
patients that have been turneddown for operations in the
past, but unfortunately,really need treatment and
we’ve been able to do thatand we’ve been quite successful.