Endovascular Surgery: Big Step Forward in Stroke Prevention

January 20, 2009

Minimally-invasive procedure uses balloon stenting to repair the artery or blood vessel and restore healthy blood flow to the brain.

To learn more about the procedure, Better Health turned to Dr. Roekchai Tulyapornchote, a U.S. board-certified neurosurgeon specializing in endovascular surgery and stroke treatment. “Think of an artery as if it’s a water pipe; dirt builds up inside the pipe, and as time goes by, less and less water flows through the pipe,” Dr. Roekchai explains. “To get the water flow back to normal again, the pipe needs to be cleaned. It’s the same logic with blood flowing through an artery. When an artery’s inside walls become clogged with plaque Ý fatty deposits made of various substances including cholesterol Ý the blood flow is reduced as the artery becomes more and more constricted.

Endovascular surgery is used to repair the artery or blood vessel and restore healthy blood flow to the brain. If left untreated, the artery would eventually become completely blocked, and a resulting stroke would most likely prove deadly.”

Hi-tech Diagnosis

Endovascular surgery is just one of the many options for treating patients with narrowing arteries or blood vessels. A number of diagnostic tests are available to assess each patient’s individual medical situation and to help determine whether the procedure is the best course of treatment. Your doctor may recommend one or more of the following diagnostic tests:
  • Carotid Duplex Ultrasound This procedure uses sound waves to measure the extent of plaque build-up in the carotid artery and provides an assessment of current blood flow to the brain.
  • Magnetic Resonance Angiography (MRA) This test involves the use of high-resolution magnetic resonance scanning technology and radio waves to create highly-detailed images of the brain’s blood vessels.
  • CT Angiogram This diagnostic procedure involves the injection of contrasting dyes that allows the doctor to locate the precise areas of blockage or narrowing. Detailed three-dimensional images are produced by a state-of-the-art 64-slice high-speed image scanner.

The Right Candidate

Endovascular surgery will be among the leading treatment options considered in cases where diagnostic tests show a 50 percent or greater reduction in the diameter of the affected artery or blood vessel.

“We use the word consider because not every patient with arterial blockage is a candidate for the procedure,” says Dr. Roekchai. “Other factors, such as the presence of co-existing health conditions like heart disease or kidney problems, need to be taken into consideration. We must weigh the advantages against the possible disadvantages as surgery can have an impact on other aspects of a patient’s health.”

Endovascular surgery is most often recommended for patients whose arteries have narrowed at least 70 percent, as they are at serious risk of suffering a stroke within two years of diagnosis. The surgery may also be recommended for certain patients with less serious blockage -- above 50 percent but less than 70 percent -- depending on their individual circumstances.

Dr. Roekchai Tulyapornchote “There are many factors to consider in determining whether the surgery is the best treatment option for an individual patient,” Dr. Roekchai explains. “The pace of disease progression, the patient’s overall health, and potential complications or side effects are among the factors that are considered in deciding the best course of treatment.”

How The Procedure Works

Endovascular surgery is a minimally-invasive procedure directed at the inside of an artery or blood vessel. The procedure begins with a small incision made near a major blood vessel in the groin area. The surgeon then inserts a tiny tube called a catheter until it reaches the blocked artery or blood vessel. The tip of the catheter carries a balloon that is inflated inside the artery. A mesh stent is then inserted inside the expanded artery; the stent remains there to keep the artery from narrowing and to strengthen the artery. To guard against new blockages, a tiny protective filter is used during the procedure to catch any dislodged plaque or clotted blood particles.

“A typical procedure lasts only about 30 to 35 minutes from start to finish, and anaesthesia is usually not needed,” notes Dr. Roekchai. “The balloon and stenting steps take only a few minutes.” The minimally-invasive procedure requires a tiny incision (less than 3 mm), and usually requires just one night’s stay in the hospital.

Second Chance For Healthier Living

Endovascular surgery has an impressive record for safety and efficacy. As with all medical procedures, there are potential risks and side effects, and not all patients are suitable for the surgery. It’s also not intended as a substitute for healthy living. Patients should follow their doctor’s advice for maintaining good health habits following the surgery, to keep their newly-repaired arteries healthy and unobstructed. Research has shown a recurrence rate of about four percent for patients who have undergone the endovascular operation.

“The surgery can’t totally eliminate the possibility of the blood vessels narrowing again in the future,” says Dr. Roekchai. “Patients still need to take control of their day-to-day health. Some patients do undergo the procedure more than once, but it’s better to live healthy and avoid the need for another surgery.”
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