Stroke Prevention: New Carotid Artery Treatment | El Camino Hospital
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 phenomenon that builds up in the arteries, and a lot of people probably are familiar with the plaques in their coronary arteries and their hearts and it's the same process affects the internal carotid 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 arteries that supply blood to the brain. Most people believe that it's a lack of flow that causes strokes and embolic events, but in fact, it's the plaque that builds up in the carotid arteries much like in the heart and pieces of that plaque fly off and end in one of the terminal vessels in the brain that supply function and sensation to an arm or a leg per se. So the surgical procedure is actually incision about that big on 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 patients under a general anesthetic. The procedure takes about an hour or hour and a half where the carotid artery is dissected out, blood is temporarily shunted around the carotid artery where there is a stenosis, and the plaque is actually scooped out with some fancy surgical instruments. So once the plaque is removed, the source of these clots and plaque that fly to the brain are thus removed thereby leaving the patient with absolutely no risk for future embolic phenomenon from that plaque.
There's a, there're a couple of reasons why patients would be referred to a vascular surgeon for a carotid endarterectomy or carotid surveillance. Oftentimes patients are screened in their primary care physician's office with a simple test where a stethoscope is put on the carotid arteries on both sides and the physician may hear what we call a bruit, which is an abnormal sensation or abnormal flow of blood that's perceived through the stethoscope. Now what that oftentimes represents is a stenosis that requires further workup and oftentimes patients are then referred to a vascular surgeon to obtain that workup. The workup can be done usually painlessly which is done with an ultrasound and that gives us an indirect measure of how tight the stenosis is, that's the best way to come to a vascular surgeon's office. Another reason why someone might be referred to a vascular surgeon's office is if the patient complains of numbness or tingling in an extremity or oftentimes dropping their coffee mug for no reason, a droopy lip, slurred speech, things like that, which we call a transient ischemic attack which again represents the embolic phenomenon from that plaque that flies off into the brain that controls the hand, the lip, the vision, etcetera. So that would be another reason why someone would be referred to a vascular surgeon.
Carotid endarterectomy is probably one of 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 demonstrated that carotid endarterectomy is a very safe procedure, it's a goal standard procedure against all other carotid interventions which are done and it's been documented very well that it's safe in patients up to 90 years old with exceptional results. Here at El Camino Hospital again we're able to offer through the expertise of a group of physicians the best possible operation for 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 approach to treating the carotid endarterectomy problem. That would require threading a catheter or wire through one of the arteries either in the groins or even in the arms and placing a stent which is very unobtrusive and has of date exceptional outcomes as well.
Now again, we have been at El Camino Hospital pushing the envelope in terms of complexity of cases and tackling cases that have been turned down by many surgeons and interventionalists elsewhere. El Camino Hospital through the administration, through the staff and through the expertise of many individuals has offered patients and offered me the ability to work in an environment that takes the expertise of not one individual but a whole team of people including interventional radiologists, interventional cardiologists, and vascular surgeons. The beauty of our program is the fact that if a patient comes in 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 patient or this is your patient. This is based on the patient's presentation and their clinical scenario where we can say, you know what, this patient probably needs your input more than it needs my input or this patient probably needs both of us to work together and collaborate on this and we've done that and have been supported in doing that by the administration very well and we've had fantastic outcomes, and again, I've been able to treat many patients that have been turned down for operations in the past, but unfortunately, really need treatment and we've been able to do that and we've been quite successful.
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