MDNews - Long Island

M D N E W S . CO M ■ MD NEWS Long Island | 1 5 "I've been treating patients using endovascular methods for more than 30 years. I have extensive experience with all aspects of this condition. I consult with my surgical partner Dr. Brisman to ensure all indications are taken into consideration and that each patient receives the most appropriate treatment." — John Pile-Spellman, MD, FACR, interventional and endovascular neuroradiologist at NSPC WARNING OF FUTURE EVENTS NARROWING OF THE carotid artery leads to symptoms related to loss of blood flow to the brain and eye. Severe stenosis increases the risk for pieces of plaque to break off and cause a temporary blockage, which can lead to transient ischemic attack (TIA), a cerebral vascular accident or transient monocular blindness (TMB). "Often, when a patient experiences a transient event, it may be associated, through imaging confirmation, with a stronger event, and not just a TMB or TIA event," says John Pile-Spellman, MD, FACR, interventional and endovascular neuroradiologist at Neurological Surgery PC. "When patients begin to have these events, the chance of them experiencing a secondary event in the following weeks is very high. It's during this early period that treatment, such as endarterectomy or carotid stenting, should be considered. The longer the delay in treatment, the less benefit of the procedure." According to the CDC, TIAs are warning signs for future events. More than one- third of people who suffer a TIA will have a stroke within one year without treatment, and 10 to 15 percent of people who have a TIA will have a stroke within three months of the first event. and Pile-Spellman provide the spectrum of carotid stenosis treatments, including carotid artery stenting to prevent stroke or transient ischemic attacks (TIAs) in patients with symptomatic or asymp- tomatic carotid stenosis. "Many people develop carotid artery stenosis, and the more occluded the artery is, the more likely it is that a piece of plaque will break off and cause a cerebrovascular event," Dr. Brisman says. "Once patients suffer one such event, they're more likely to experience a second or third. Before surgery, we carefully weigh each procedure's risks and benefits. We strongly recommend surgical intervention for patients who have already experienced a stroke or TIA, or those whose carotid artery is more than 75 percent stenotic. Age also factors heavily into the care plan." In general, surgery is recommended for symptomatic patients who have nar- rowing greater than 50 percent. Patients who are asymptomatic are recommended for surgery if they have narrowing greater than 75 percent and are 75 years old or younger. A Snapshot of Risk Although carotid stenosis commonly affects the elderly, a number of risk fac- tors — including high cholesterol and/or blood pressure, smoking, diabetes, obe- sity, metabolic syndromes, and insulin Jonathan Brisman, MD, and John Pile-Spellman, MD, FACR, review images of a patient referred for carotid stenosis evaluation and possible stenting. Dr. Brisman auscultates a patient for carotid bruit, a sign of significant carotid stenosis.

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