Joey Wahler (Host):
It causes up to one-third of all strokes, so we're discussing carotid artery
disease and how to treat it. Our guest, Dr. Jorge Eller. He's a board-certified
and fellowship-trained cerebrovascular and endovascular neurosurgeon, part of
the Crouse Health neurosurgery team.

Host: This is Crouse Healthcast, a podcast from Crouse
Health. Thanks for listening. I'm Joey Wahler. Hi, Dr. Eller. Thanks for
joining us.

Dr. Jorge Eller: Hi, Joey. Pleasure to be here.

Host: Pleasure to have you. So first, for those uninitiated
here, where are our carotid arteries in the first place? Where are they
located? And in a nutshell, what do they do?

Dr. Jorge Eller: Right. So, the carotid arteris are the
two main suppliers of blood to the brain. So, they're located in our neck. On
either side of the neck, you can actually feel it. You are able to palpate the
carotid just by gently putting your two fingers on the side of your neck
muscle. You can feel the heartbeat there. Those are the two main vessels that
provide blood supply to the brain.

Host: And so, carotid artery disease is also known as
carotid stenosis. So, what is that and why is it so crucial to avoid?

Dr. Jorge Eller: So, carotid disease or carotid stenosis
is a narrowing of the diameter of the carotid. So essentially, the blood vessel
becomes smaller. And so, you have less blood flow to the brain. And obviously,
the reason this is important is because with less blood to the brain, the brain
has potentially less ability, less hemodynamic reserve, if you will. And obviously,
the main importance of this, is that, as you mentioned in the introduction,
it's a major risk factor for a stroke.

Host: And so, who generally speaking is most at risk for
carotid disease?

Dr. Jorge Eller: The risk factors for carotid disease
are essentially the same for risk factors for vascular disease elsewhere,
including the heart. So, things like high blood pressure, uncontrolled
diabetes, high cholesterol. As a matter of fact, the narrowing of the carotid
artery is usually caused by what we call a plaque, which is consistent with
cholesterol and platelets, which are a constituent of the blood that forms
clots, right, the cells in the bloodstream that lead to clot formation. So,
they can get stuck to this cholesterol layer in the carotid, and there's
sometimes some calcification there. So, all these different risk factors
essentially affect blood vessels anywhere in the body. And obviously, the
carotid is one of the main sites where such we call them atheromas or
atherosclerotic plaques develop. Another reason for that is that there's a
bifurcation there. So, there's like a big vessel called the common carotid, and
it splits into the internal carotid and the external carotid. So, where those
bifurcations happen is an ideal place for this plaque to form and for the
vessel diameter to narrow significantly. Another important risk factor, by the
way, is smoking cigarettes, which is really bad for your blood vessels. As much
as it is bad for your lungs, it's also very bad for your blood vessels.

Host: Interesting that you mentioned that because I
wasn't aware of that. Do you think that gets overlooked because there's such an
association between one and not the other?

Dr. Jorge Eller: Yeah. It's a very common thing for us
who see patients with carotid disease and cerebrovascular disease on a daily
basis. And a lot of times those folks are heavy smokers. And so, it is clearly
a very important association.

Host: So, what are the typical symptoms of blockage in a
carotid artery?

Dr. Jorge Eller: Essentially, the symptoms associated
with carotid stenosis are the same symptoms that one would associate with
stroke. Weakness on one side of the body or the other, numbness or tingling on
one side of the body or the other, trouble with vision. Actually, a very common
symptom is a small little piece of that plaque that I described before that
breaks off and migrates distally and ends up in the small blood vessel in the
eye, as a matter of fact, and give you a little retinal stroke. And so, it's a
very common symptom called amaurosis, which is visual loss associated with
this. One could have trouble with speech. And those symptoms can be either
permanent, which would be a stroke, or they could be temporary, that's called a
TIA or a transient ischemic attack, which means it's almost like a warning sign
that something really bad is about to happen. And if anybody has any of those
symptoms, especially if they come and go, one has to be very aware of the fact
that this could be an impending stroke about to happen, and you should not
waste any time whatsoever and come to the hospital.

Host: Right. Because obviously once a stroke begins,
time really becomes of the essence and minutes could be the difference between
life or death in terms of someone being treated in time, right?

Dr. Jorge Eller: Correct. Absolutely. Time is essence. I
would dare say that in the entire field of medicine, there is no other
condition more time-sensitive than stroke. And as we talked in the beginning of
this conversation, carotid artery disease is one of the major risk factors for
stroke. So if any of those symptoms happened, that's the main message every
time we talked about this. Please don't waste any time. Come to the hospital.
Call 911. Have the paramedics, the EMS folks bring you into the hospital to be
evaluated, even if the symptoms resolve. Because as I said, this might be just
a warning sign and you need to be evaluated because if you have a severe
stenosis of your carotid and something really bad is about to happen, we can
prevent it from happening, if we can get in there in a timely fashion.

Host: And speaking, doctor, of prevention, you were just
talking about trying to do so on your end. But on the patient's end, in terms
of trying to head this off at the pass, from those you see on a daily basis,
what's the one thing that people have most control of in their own lifestyle
that can bring this condition about that you want to warn people they can
change on their own?

Dr. Jorge Eller: Well, Joey, the factors that prevent
carotid disease are the same that prevent vascular disease, cardiac disease.
For example, controlling blood pressure, controlling diabetes, making sure that
you know what your cholesterol and lipid levels are and, if necessary, control
and take medicines for hypercholesterolemia, a healthy lifestyle in terms of
diet and exercise and, most importantly, not smoking cigarettes. Smoking
cigarettes is actually one of the significant risk factors for vascular disease
as much as for lung cancer, and most people may not even be aware of that.

Host: Gotcha. So moving on, what are the treatment
options should someone have carotid stenosis?

Dr. Jorge Eller: Well, the treatment options are
essentially split in three separate possibilities. One is medical management
when somebody has some carotid disease, but it's not severe enough to require
intervention, either surgery or endovascular intervention. And medical
management consists of what i just described before as far as preventative
measures in addition to in terms of medicine, aspirin and Plavix, which are
very common, we call them antiplatelet agents. So, those are common medications
that are very commonly used to prevent worsening of vascular disease anywhere
in the body, including the carotids as well as treating a hypercholesterolemia,
right? The high cholesterol levels need to be medicated. And now, that we have
the statins, which are also very good medications for that purpose. So, a
combination of antiplatelet agents and statins is a very good combination to
treat carotid disease as long as it is mild, right?

If you go beyond a certain threshold, then you have what we
call interventions, and that splits in two options. One is open surgery, which
is a procedure called carotid endarterectomy. And the other option is a more
minimally invasive option, which is called an endovascular stenting. So, both
options actually work really well. And the intervention piece of this, either
by open surgery or by the endovascular route, referred to essentially reopening
the vessel. So, that narrowing that I described before, which is what the
disease is about, essentially is reversed by either doing surgery on the blood
vessel or by putting a stent within the blood vessel.

Host: And so, how do you diagnose which treatment is
best?

Dr. Jorge Eller: The decision about which way to go how
to treat the carotid has to do with many factors that are very individualized.
And so, there's no one-size-fits-all. But in general, we look at whether or not
the patient has symptoms, right? Sometimes the carotid disease can be picked up
on routine checks with your primary doctor, right? You're just going for a
checkup. You have a doppler study that shows the narrowing. That sometimes
requires treatment as well. If it is very significant, like 80% or greater, we would
recommend some sort of intervention. But if you have symptoms, then that
threshold's a lot less, it would be 50% or greater, we would recommend an
intervention. So, it depends on the degree of stenosis, it depends on whether
or not it's symptomatic or not symptomatic, and then to decide if you are going
to do this via an open surgery or via a carotid stenting procedure, it depends
on the anatomy. Some patients' vessels, some patients' carotids are more
amenable to the open surgery because depending on the tortuosity and how much
calcification is there and all of those things, maybe the stenting is not a
good option. Conversely, if somebody has had surgery before in the neck or if
somebody has a lot of other medical issues that would make surgery not advisable,
then the carotid stenting procedure is the way to go because that can be done
under local anesthesia, you don't have to be under general anesthesia. It's a
much easier and quicker procedure. And so, the decision is very individually
based and has to do with all those different factors which have to be taken
into account at the time of the individual patient evaluation.

Host: And so, obviously, a number of different options
and a number of decisions and factors that go into that. So in summary here, doc,
why is Crouse the best place to go to treat carotid stenosis?

Dr. Jorge Eller: Well, we at Crouse are proud to say
that we have all the elements in place to provide a very comprehensive,
multidisciplinary care for patients suffering from vascular diseases in
general, cerebrovascular diseases in particular, right? So, we have a well
trained, well experienced team of physicians, cerebrovascular surgeons such as
myself, vascular surgeons. We are able to do all those procedures that I talked
about, either open surgery or the carotid stenting. We can do all of it under
one roof and able to provide a comprehensive evaluation of what is the best
treatment for any individual patient. And that is one of the pinnacles of our
work in preventing strokes and treating strokes, something that we're very
proud here at Crouse.

Host: Well, obviously, a very, very specialized area of
medicine to say the least. Folks, we trust you are now more familiar with
carotid artery disease and its treatment. Dr. Jorge Eller, very educational,
very informative. Thanks so much again.

Dr. Jorge Eller: My pleasure. Have a great day.

Host: Same here. You too.

And for more information,

Joey Wahler (Host): please visit krause med.com/george
er MDM B. That's Krause med.com/george, J O r G e, Eller hyphen mba.

Host: Now, if you found this podcast helpful, please
share it on your social media. And thanks again for listening to Crouse
Healthcast, a podcast from Crouse Health. Hoping your health is good health.
I'm Joey Wahler.