Brain Power: Carotid Artery Disease [2 of 3] - Penn State Hershey Neuroscience Institute


Uploaded by PennStateHershey on 29.12.2010

Transcript:
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>> You're watching Brain Power Carotid Artery Disease on abc27. Brought to you by Penn State
Milton S. Hershey Medical Center.
>> Welcome back Dr. Harbaugh. Now, if medication itself doesn't work, what are some of the
options for treating this disease?
>> Well, in addition to the medical management, you can treat carotid artery disease with
invasive procedures including angioplasty and stenting or carotid endarterectomy.
>> Alright, let's start with the first 2 options. You've mentioned angioplasty, stenting and
people hear about that, they think the heart and so on, talk about that. What's that mean
in this case?
>> It's a similar procedure to what is done for coronary arteries catheters placed in
usually in the femoral artery in the leg and then it's worked up through the arteries through
the abdomen and chest and into the carotid artery at the area of narrowing, a balloon
is inflated to open up the vessel and a stent of metal cylinder is put in there to help
keep the vessel open.
>> What are the risks with this kind of procedure?
>> The risks of this kind of procedure carry the risk of any invasive surgical-type procedure,
bleeding and infection and there's also a risk of stroke and because people with carotid
artery disease may also have coronary arteries disease, the stress of the procedure may cause
a heart attack.
>> Are you talking about a procedure? I wanna make sure I get this carotid endarterectomy
procedure. How does risk compared to the angioplasty and forgive me, the first one.
>> Angioplasty and stenting--yeah.
>> How do they compare?
>> Well, I think there have been a number of good studies coming out both in North America
and in Europe that indicate that the stroke risk with carotid endarterectomy is a bit
lower than the stroke risk with angioplasty and stenting. The most recent study that came
out suggested that the cardiac risk from endarterectomy were higher than they were for angioplasty
and stenting.
>> Now, I find this fascinating that the patients are awake for the surgery. That's just not--if
I'm lying on table, that sounds that unnerving.
>> Right. Well both procedures can be done either with a general or local anesthesia.
I've done all of my carotid surgery with a local anesthesia since 1992 and I think there's
a benefit to that on reducing the risk of the heart and lungs and we also have an awake
patient that we can monitor minute to minute regarding his neurological status. Patients
are numbed up so it doesn't hurt. They can't see the incision. And most people initially
don't like the idea of awake surgery but come back to the clinic saying, "I'm glad I did
that way."
>> That's good to hear. Thank you doctor and Debra Pinkerton, she's here now to tell us
about another patient who had this procedure. Debra.
>> Chuck, our next story is about a Lebanon county man who is ready to enjoy Christmas
last year but instead, spent most of the holiday in the hospital.
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>> Eighty one-year old Seth Huisman [phonetic] is a pretty good pool player.
>> Five ball in the corner.
>> One by one, he sinks them. The balls fall so easily into the pocket and last December,
it was Seth who fell so easily onto the floor at Saint Andrews Presbyterian Church.
>> We had gone to church on Christmas Eve with the idea for participating in the choir.
As we were proceeding to the choir room, there's a coat rack and I stopped at the coat rack
to hang up my coat and that's just simply the last thing that I remember.
>> One of the gentlemen in the choir came over and very calmly said, "Now don't get
upset, but Seth is out in the hall on the floor." So I went out there and there he was
and unable to find words and scared me half to death.
>> Seth had a stroke. He spent several days at a local hospital and went home but not
for long.
>> I was sitting there at the dining room table right after dinner and suddenly, my
speech power sort of disappeared and my son and daughter looked at me and said, "Dad,
you're crashing."
>> His face had kind of sad and he was again not only finding it difficult to form a word
but he just wasn't able to speak.
>> This time, Seth went to Penn State Hershey Neuroscience Institute. An MR angiogram revealed
the problem.
>> You feel the carotid arteries coming out. You can see these vessels are both quite robust.
On this side, right at this spot, there's almost no flow through here. You can see it
reconstitute farther down but this is a very, very narrow vessel and this is the source
of his stroke.
>> In order to--for me to really return to a lot of activity, in order to really be able
to keep on going, it was his judgment that they needed to open the artery.
>> He said I think he's a perfect candidate for this and I think he should have it right
away and so did we. So I wasn't one bit hesitant about doing it.
>> On New Year's Eve, Dr. Robert Harbaugh performed the surgery.
>> I was so glad to see him come out and give me that good sign that everything was okay
and--
>> I think it's important, you know, to go find the family as soon as you're done because
they're sitting there chewing their nails to the quick waiting for information.
>> He explained everything and how well he had come through the surgery and that he should
be okay. And those are the words I was waiting for.
>> The doctor told me I was gonna be fine. I had high hopes that he was right and he
was.
>> This is the kinda guy who's probably gonna be going strong at 90. The fact that he could
get back to doing all the things that he wanted to do right away was important for him.
>> He's doing so well. I hardly see any difference in him now than before the stroke. I really
can't say that he has changed very much.
>> I think I probably feel better that I didn't know it at the time but I probably feel better
now than I did before because like I said, I eat better and exercise more. I'm enjoying
life.
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>> And as you could see, Seth is enjoying life. He tells me that the only residual effects
from the strokes, his right fingers are numb, but that's it. He's doing great Chuck.
>> I tell you, those great too. I think at 90 is a pretty good bet too. Now, doctor,
both these patients' stories we saw tonight, they used surgery to correct their problem,
how do you decide what is the best treatment?
>> Well, deciding what's the bets treatment for any individual patient medical treatment
alone, the angioplasty, the stenting or endarterectomy is really complicated and individualized decision
and it needs to take into account the risk of the disease in that patient as well as
the risk and benefits of the procedures that can be used to treat it and for both stenting
and surgery, the skill of the operators are very important piece.
>> Always a skill, and how long would these patients be in a hospital after the treatment?
What's the typical timeframe?
>> Nearly everybody goes home the next day and they can usually resume almost all of
their usual activities when they go home.
>> Well, thank you doctor. Let's see what viewer questions are coming in, in the call
center. Debra.
>> Thanks Chuck. We do have some more viewer questions. This is the next one. What is the
difference between a TIA and a stroke?
>> A TIA, that's actually stands for transient ischemic attack and this is a temporary event
where a blood vessel going to the brain becomes temporarily blocked. That blockage then results
in some temporary dysfunction. So numbness, weakness or paralysis but that gets better.
Now usually, this happens and it gets better in about an hour, sometimes maybe as long
as 24 hours. On the other hand, a stroke is an event that occurs that's permanent where
the brain tissue actually dies and does not recover and you're left with some sort of
permanent deficit such as again numbness, weakness or paralysis.
>> Either way, you should go to the doctor immediately.
>> Absolutely. A TIA is actually a good warning sign for a stroke and you actually recovery
completely, but yes, if you get to medical attention soon, then that can give you the
best opportunity for getting better, most interventions that are available.
>> Okay, this is our next question. I'm 70 years old and have a 78 percent blockage in
my carotid artery. At what percent blockage should I have treatment done?
>> So this is a difficult question somewhat. We kinda divide carotid artery stenosis into
a couple of categories. People that have symptoms when they have a narrowed artery and people
that don't have symptoms. If you have no symptoms and your artery is narrowed more than about
80 percent, then that's probably something that ought to be treated. It used to be a
lower number than that but now, medicines are so much better that we probably don't
need to treat ones that are less than 80 percent. On the other hand, if you have symptoms, well
then you probably ought to have your artery or consider having your artery treated if
it's--even if it's narrower than 50 percent.
>> Okay, great. Thanks so much, Dr. Cockroft. We'll be checking back with you. [Background
Music] But right now, we'll send it to a break.
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