Carotid Artery Disease and Stroke: A stroke occurs when blood flow to a portion of the brain is interrupted or there is bleeding into the brain and the tissue in that area of the brain begins to die, resulting in sudden symptoms and neurologic impairment, often referred to a “brain attack” as the neurologic equivalent of a heart attack. Every near, more than 800,000 people experience a stroke, with almost 90% of stokes being “ischemic” and related to interruption in blood flow either due to blockage of the carotid artery in the neck or due to clot escaping the heart or other vessels and lodging in an artery in the brain.
Stroke is a medical emergency and the fifth leading cause of death in the United States. Prompt treatment is critical in an attempt to save brain tissue and minimize long-term damage. Early symptoms may include:
- Weakness of the facial muscles or limbs
- Numbness or tingling
- Trouble speaking
- Severe headache
Some patients may initially show signs of a “mini-stroke” or transient cerebral ischemic attack (TIA), with symptoms that may resolve in a few days or within a day. TIA may be a strong predictor of impending stroke and should not be ignored and should be rapidly brought to the attention of your medical provider.
When stroke occurs, minutes matter. Restoration of adequate flow to the brain tissue provides the best opportunity to prevent death and limit long term disability.
Peripheral Artery Disease: (PAD) is common disorder related to narrowing and blockage of blood vessels that lead to the extremities, many times more common involving the lower extremities. Blockages result inadequate blood flow to the legs to keep up with demand for nutrients and oxygen during activity and, if severe enough, even at rest in bed at night. Decreased blood flow to the legs can lead to fatigue or weakness in the leg. One of the most common symptoms of advancing disease is cramping pain in the thigh or calf that develops while walking (claudication) and may resolve in a few minutes if standing still, only to recur when walking is resumed. Pain that occurs in the feet at night and resolved with hanging the feet over the side of the bed (rest pain) may be a sign of particularly severe blockage that prevents adequate blood flow to the limb even while resting. Such a severe degree of blockage can lead to skin breakdown (ulceration) and even death of the tissue in the area (gangrene). Some men may present to their doctor with impotence as the first sign of their arterial disease.
Peripheral vascular disease is typically caused by the buildup of fatty and calcified deposits (plaque) in the wall of the blood vessels supplying the leg and may be associated with blockages to the arteries that supply the brain and heart as well as the legs. PAD is strongly associated with smoking, diabetes and high blood pressure. Family history may play a role as well. PAD is more common in older individuals and is estimated to affect approximately 10% of Americans.
Some patients who present with symptoms such as claudication may be able to simply be treated with lifestyle modifications such as smoking cessation and establishing a regular and reasonable walking/exercise program, as well as treatment of underlying medical issues such as high blood pressure or diabetes. Diagnosis of PAD may be established by your physician by medical history and physical exam, often combined with assessment of blood flow with ultrasound examination or CT scan.
For patients with more advanced blockage of PAD that does not respond to medical treatment, several options may be available. Surgical bypass is a well-established procedure to surgically position and implant a small fabric tube across the area of blockage to redirect blood flow around the blockage and restore adequate flow to the leg. However, not all patients will be candidates for surgical repair due to health issues that may increase risks and complications. Recovery times required following surgery, as well as additional risk factors may make a minimally invasive approach to resolving the a blockage much more attractive.
Angioplasty with stenting involves placement of a small plastic catheter into the blocked artery through a small needle hole in the skin in the arm or leg. The balloon catheter is advanced to the blockage under x-ray guidance and inflated for a period of time and then deflated. The small metal mesh stent can then be advanced through or with the same catheter and deployed to maintain the vessel and prevent reformation of the blockage.
Percutaneous atherectomy may be used in combination with angioplasty and stenting, particularly in small blood vessels further down the leg or when plaque build up is excessive and may not allow initial passage or inflation of a balloon catheter. During atherectomy a small catheter with a fine cutting edge is advanced to the blockage and activated, trimming and removing obstructing plaque while simultaneous suction is applied to the catheter to remove plaque
Uterine fibroid a type of tumor in the uterus and very typically benign, that arises from the muscle tissue layer that surround the uterus. Fibroids may affect of 70-80% of all women in the United States before they are 50 years old and can present with a variety of symptoms that include:
- Uterine pressure or pain
- Heavy menstrual bleeding or cramps
- Pain during or following intercourse
- Leg pain
- Urge to urinate frequently
Some women will have one large dominant fibroid, while others may have multiple smaller fibroids that together lead to symptoms. If symptoms are suggestive of fibroid problems, ultrasound and MRI will often be order to confirm the diagnosis and define tumors that require treatment. Not all patients with fibroids will be candidates for UFE, but for those who are appropriate candidates the procedure may provide a desirable alternative to traditional surgical hysterectomy.
Fibroids require significant blood flow from the blood vessels that supply the uterus to grow and by limiting blood flow with Uterine Artery Embolization (UAE), the fibroids may greatly reduce n size with marked improvement in symptoms in over 90% of women.
During UAE. the interventional radiologist may guide a small plastic catheter into the specific blood vessels that supply the uterus and fibroid, utilizing x-ray guidance. Once in position, tiny particles are injected under x-ray control to block the vessels feeing the fibroid and starve it of flow and associated nutrients resulting in shrinkage of the benign tumor. When embolization is felt to be adequate, the catheter is removed and a small bandage placed.
Most patients are kept overnight to allow for treatment of immediate cramping and discomfort that may occur after the procedure. Some discomfort may continue for a few days up to a week, including possible low-grade fever as the benign fibroid tumors die and shrink. Risk of infection is very small but is observed and you may also be treated with antibiotics following the procedure as a precaution.