Issue link: https://viewer.e-digitaledition.com/i/580477
Dr. Pile-Spellman discusses a treatment plan with a patient. 1 6 | Long Island MD NEWS ■ M D N E W S . CO M "We're eager to help patients and other care providers prevent stroke. We also perform clot retrievals and treatment for embolic events, which distinguishes us from many other surgeons and practices in the area. Our goal is to promote optimal outcomes in all our patients by using best practices." — Jonathan Brisman, MD, board-certified neurosurgeon at NSPC resistance — can increase the chances of developing stenotic carotid arter- ies. While medical management and lifestyle changes can mitigate some risk factors, surgical intervention may be necessary to open the artery and reduce the risk of cerebrovascular events. Stroke is responsible for nearly one out of ever y 20 deaths, or 130,000 deaths annually, according to data compiled by the CDC. One out of six people will experience stroke in his or her lifetime. An estimated 795,000 people experience a stroke every year, and of that number, about 185,000 strokes occur in people who've had a previous stroke. Additionally, the fina ncia l burden of stroke weighs heavily upon healthcare entities and patients — strokes annually cost an esti- mated $34 billion in costs for related ser vices, medications for treatment and missed workdays, according to the CDC. Symptomatic carotid stenosis is, by some estimates, responsible for 25 percent of all ischemic strokes. In a chapter included in Surg ical Management of Symptomatic Carotid Disease: Carotid Endarterectomy and E x t r a c r a n i a l-In t r a c r a n i a l B y p a s s, Dr. Brisman — who also co-edited the volume — provides evidence that endarterectomy can reduce the risk of stroke for symptomatic carotid stenosis. He also presents recent studies that show carotid angioplasty and stenting to be an effective treatment for patients who are at high risk for complications during carotid endarterectomy. "Diseases such as chronic obstruc- tive pulmonary disease [COPD] and emphysema put patients at higher risks for complications related to general anesthesia," Dr. Brisman says. "For such patients, we would likely recommend carotid stenting." Dynamic Procedures Once considered the gold standard for carotid stenosis treatment, carotid endarterectomy can also be used as a prophylactic measure against future strokes. During the procedure, surgeons make a small incision in the neck to remove plaque buildup from the lumen, or inner walls, of the carotid artery. Carotid stenting is an alternative treatment for patients with symptom- atic carotid artery disease. Typically, patients who undergo carotid stenting have experienced a stroke prior to inter- vention, according to Dr. Pile-Spellman. Before placing the stent, surgeons perform a carotid angioplasty. Local anesthetic is administered in the groin, where the catheter is inserted. Surgeons use real-time X-ray imaging to guide the catheter to the blocked artery and inflate the small balloon on the cath- eter's tip to crush the plaque against the lumen, reestablishing blood flow. After the artery has been reopened, surgeons place a stent to prevent subsequent cerebrovascular events. Both procedures lower the risk of stroke, or ischemic attack, and prevent future strokes. Evidence-based Indications Dr. Brisman's research compares the efficacy of carotid endarterectomy and carotid stenting based on major clinical trials of each procedure. One major takeaway from the literature is that surgeons must be war y of a number of highly specific indications that can influence surgical outcomes for either intervention. Carotid artery stenting is less inva- sive than carotid endarterectomy and can typically be completed in one to two hours. The fact that the procedure can be performed using local anesthesia extends a critical treatment option to patients who are contraindicated SPECI A L FE AT UR E