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MarinHealth Introduces New Carotid Artery Procedure To Prevent Stroke

May 7—Jim Williams of Novato was suffering from severe carotid artery stenosis, meaning the artery walls in his neck were blocked with plaque, increasing his risk of stroke.

Williams, who turned 76 on Saturday, previously experienced a transient ischemic attack, or ministroke, so traditional open surgery was not ideal because of the high risk for complications involved.

His vascular surgeon, Dr. Allan Conway at MarinHealth Medical Center, had the solution: a new, minimally invasive procedure called transcarotid artery revascularization. The procedure was successfully completed on Thursday, making the Greenbrae hospital the first in Marin County to accomplish the task.

"We are extremely grateful to Dr. Conway and his talented team for bringing this highly innovative and lifesaving procedure to MarinHealth and the community at large," Dr. David Klein, chief executive officer of MarinHealth said in a statement.

"Once again, MarinHealth stands at the forefront of clinical excellence, providing our patient populace with the most cutting-edge procedures," he said.

Conway, a vascular surgeon at Lenox Hill Hospital in New York City for 10 years who served as an associate professor of surgery and program director of the vascular surgery residency, joined MarinHealth in November.

Transcarotid artery revascularization, or TCAR, is a 45-minute procedure that involves a surgeon slicing a small incision in the neck.

Conway said this allows him direct access to the carotid artery so he could place a stent inside to stabilize the plaque. The technique also involves connecting the carotid artery to a system that redirects blood flow, so that loose plaque does not drift upstream to the brain during the procedure.

"What's most exciting for me is what it enables us to do in Marin," Conway said. "Now we can treat carotid artery disease with all approaches.

"My impression is that the outcomes are so good," he said, "that in the next few years we will see that rise." He said "it's less invasive and the outcomes match the gold standard."

The gold standard has been the open surgery method called carotid artery endarterectomy, Conway said. The procedure involves the surgeon making a larger incision, which could produce more visible scarring; it takes about two hours to perform and it requires an average of three days in a hospital bed for recovery.

One of the problems is, for high-risk patients, the procedure itself could induce a stroke, Conway said. In addition to being lower risk and less invasive, the TCAR method is quicker to perform, and the average patient is released from the hospital after one night, Conway said.

MarinHealth performs about 70 to 80 carotid artery surgeries a year, Conway said. He expects that at the start, about 20% of future procedures at the Greenbrae hospital will be done using the TCAR method.

(c)2023 The Marin Independent Journal (Novato, Calif.) Distributed by Tribune Content Agency, LLC.

A Stroke Left My Husband Unable To Speak. It Took Me A While Before I Realized He Was Still Communicating Without Words.

Christina Dyar.Courtesy of the author

My husband of 35 years had a stroke that left him unable to speak.

He could walk, squeeze my fingers, and lift his legs, but only sounds came out of his mouth.

Me trying to force him to communicate frustrated us both, so I stopped.

One day my husband, Hunt, stopped making sense. Food fell out of his mouth and became stuck in his beard. His arm was bent oddly, hanging closely to his chest. Paramedics clustered around him in our Indiana home, but before I could process it, he was helicoptered to the nearest level-one trauma hospital and rushed into surgery. Hours later, in a crowded four-person ICU, I held his hand. He didn't speak or open his eyes, but he did make odd sounds. I was so relieved that he was, that I didn't focus on anything else.

He had a stroke, but we didn't know how it'd impact him

"Occluded left carotid artery with a large blood clot and infarct in central and posterior main arteries" was his diagnosis. Translation: He'd had a stroke. But what that meant, exactly, no one could say — not CT scans, MRI scans, or doctors and their posses of students, residents, and postdocs. Global aphasia. Paraphasia. Fluent aphasia. Expressive aphasia. Words that labeled but didn't provide a prognosis.

The good news was that physically he was fine. He looked the same. He could walk, squeeze my fingers, and lift his legs. But to tell anybody how he was feeling, or if he was seeing double, or to ask for a glass of water? Nothing but garbled sounds came out. A cruel fate for a man who loved connecting with people and made his living — as a high-level salesman — talking.

I kept pushing him to communicate with me

I was obsessed with his recovery — wanting him to return to the voluble partner and father of three kids I'd been married to for 35 years — so I looked for interventions. I drove him to various therapies. I drilled him and drilled him again. Angry, scared, missing him, and grieving, I pushed and nagged him to practice.

Story continues

Spontaneous recovery, while technically still possible, was a long shot. The biggest window for neuroplasticity — using other parts of the brain for functions usually handled by damaged areas — was shrinking. New studies say that never ends, growth just slows, but still, I felt the clock was running against us. Panicked, I organized games, got Legos and jigsaw puzzles to put together, insisted he finish his therapy homework, and signed him up for aphasia Zooms and webinars.

He just wanted to take naps.

Medical journals offered no answers. I searched for someone whose experience was similar to his but who had recovered — someone who spoke, read, and wrote. Someone to point the way. Everything I read was meaningless and vague.

"Find new ways to communicate," one brochure said. I mentally flipped the bird. How was I supposed to do that?

He hated how I threw out one word after the other, trying to guess what he wanted to say. That frustrated him and he shut down, stopping my search for context.

When I realized he was actively trying to temper his frustration with me because he didn't want to be a burden, I cried for the first time.

We went to a support group at a local university. He loved it, immediately becoming a leader in his Uno group, pointing and fist-bumping. Not long after, I watched as he interacted with the nurse taking his blood labs and noticed how he exaggerated his gestures and made faces, successfully making her laugh. I could almost hear him asking if she had any pets, his standard small talk. Suddenly, I saw him. The same man. He was still here.

In my focus to help, to fix him, to give him words, had I missed the point? He was communicating, I just wasn't listening.

We no longer finish each other's sentences. He watches TikTok and laughs. I read. The dog and cat don't miss the absence of intelligible words, but they understand the tone of his sounds and snuggle up to him.

The silence is no longer lonely. My love is still here.

Read the original article on Insider

EVAR Vs Aneurysm Activity; Carotid Stenosis Inaccuracy; More PAP In Heart Failure?

In patients with abdominal aortic aneurysms, endovascular aneurysm repair was shown to reduce aortic microcalcification and disease activity according to fluoride-18 uptake. (Heart)

There was a shrinking of small abdominal aortic aneurysms upon high-dose administration of immune-modulating stem cells in a preliminary study highlighted by the American Heart Association.

Records from carotid stenting facility accreditation review show that real-world operators tend to overestimate carotid artery stenosis, perhaps affecting decisions around carotid revascularization. (Stroke)

Postmenopausal women with a greater atherosclerotic burden were at higher risk of heart attacks than men of similar age, suggesting a higher dose of statins or the addition of another lipid-lowering drug for this population. (European Heart Journal - Cardiovascular Imaging)

Older people who met intensive blood pressure lowering goals did have fewer cardiovascular events over more than 3 years of follow-up in the STEP trial. (European Journal of Preventive Cardiology)

Assessed by artificial intelligence-powered quantitative flow ratio, residual ischemia after left main bifurcation stenting was associated with 3-year cardiovascular mortality, according to an observational report. (European Heart Journal)

Several available software products computing angiography-derived fractional flow reserve showed good diagnostic accuracy according to an independent core lab -- but not to the level reported from validation studies of the vendors. (JACC: Cardiovascular Interventions)

Skeletal muscle mitochondrial dysfunction may play a role in exercise intolerance among patients with heart failure with preserved ejection fraction. (JAMA Cardiology)

Heart failure patients who were more adherent to positive airway pressure therapy for concomitant obstructive sleep apnea tended to require fewer hospital visits. (Journal of the American Heart Association)

Early pulmonary artery catheter use was associated with better survival in heart failure-related cardiogenic shock. (Journal of Cardiac Failure)

In Korea, the socioeconomic disparities in out-of-hospital cardiac arrest care were partly mediated by potentially modifiable factors such as witnessed status and provision of coronary angiography. (JAMA Network Open)

Samsung had the irregular heart rhythm notification feature of its smartwatch software cleared by the FDA. (Mass Device)

For patients with pulmonary hypertension and supraventricular arrhythmias, extensive radiofrequency catheter ablation resulted in less arrhythmia recurrence at 13 months than clinical arrhythmia ablation alone. (EP Europace)

Scientists identified new contributions of genetics to congenital heart disease with the discovery of splice region variants on RNA splicing. (Circulation: Genomic and Precision Medicine)

Newborns with critical coarctation of the aorta had biventricular systolic function restored with transcatheter or surgical repair, according to a small single-center report. (JACC: Advances)

Denver cardiologist Stephen Matthews, MD, was arrested again with the surfacing of nine more criminal cases related to alleged sexual assault. (CBS News)

Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

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