Caitlin Whyte (Host): Welcome to Living Well with Eisenhower Health, healthcare as it should be. I'm your host, Caitlin Whyte. Joining me today is Dr. Anthony Alastra, a Neurosurgeon from Eisenhower Medical Center. In this episode, we're diving into the fascinating world of neuroscience and neurosurgery of the brain.

Well, Doctor, as a neurosurgeon, can you give us an idea of the types of conditions that you treat?

Anthony Alastra, MD: Sure. Neurosurgery basically encompasses any condition that involves the brain, the spine, the nerves that come from the brain and the spine, and then the structure surrounding it, such as the skull, the vertebral column, the spinal column surrounding the spinal cord, and the soft tissues involved with that.

Host: Gotcha. Well, today we are focusing on advancements in the treatment of vascular diseases in the brain. Can you name some of these conditions for us and how they present themselves?

Anthony Alastra, MD: Vascular disease can encompass a range of different entities and can present with multiple different types of conditions or symptoms. The most worrisome is anything that sounds like a stroke. So weakness or numbness on one side or both sides of the body, problems speaking, problems, acute problems with vision, and then more dangerous hemorrhagic conditions related to the vasculature could present with severe headache, changes in mental status like that lead to coma ordecreases in the ability to reason or do other types of activities. So, it ranges, but, but mostly what we're worried about is anything that could potentially be concerning for a stroke-like condition.

Host: All right, and what's happening in the brain that causes these conditions?

Anthony Alastra, MD: Well, the blood vessels that supply the brain obviously can be affected by different types of conditions, just like the rest of the vessels of the body. You know, we talk about hardening of the arteries causing atherosclerotic disease, and that of course can affect the brain just as much as it affects the heart or other parts of the body. So, for example, atherosclerotic or hardening of their arteries in the carotid arteries in the neck can lead to decrease in blood flow in the brain, which can then lead to stroke-like symptoms and that has to be treated.

Another example are intracranial aneurysms, or abnormal little bubble weaknesses on the blood vessels that then can grow and then can either press on nerves or structures or the worst scenario, rupture and cause a hemorrhage, which could lead to different types of conditions, even death. So all of these types of vascular conditions, essentially anything that can affect a blood vessel, they're going to be the potential to affect the brain and the spine.

Host: And looking at treatments now, do they always involve invasive procedures or surgeries?

Anthony Alastra, MD: Not always. For certain types of vascular disease, the medical therapy is preferred and usually requires some sort of treatment of underlying hypertension, triglyceridemia or high cholesterol. So you're treating, you know, with blood pressure medicines, cholesterol medicines to kind of treat the, the natural problems of the, of the vascular system.

And then on top of that, we try to prevent blood clotting or thrombosis. So platelet inhibitors, aspirin, Plavix, Brilinta, those types of medicines. And then anticoagulation with Warfarin or Eliquis as you'd see with someone with atrial fibrillation, you know, abnormal beats of the heart. That type of treatment as well can be the all that's needed to, to prevent problems in the brain, as opposed to invasive treatments, but, which do sometimes need to be performed.

Host: Well, what are you seeing in terms of new advancements in treating these conditions?

Anthony Alastra, MD: What we're seeing on different fronts, in the atherosclerotic front where we're talking about hardening of the arteries or buildup of plaque in the arteries that affect the brain; we are definitely seeing advancement in our endovascular techniques for treatment. We're seeing advances in stent technology to basically bridge across these hardening points in the brain.

New technologies toprevent the recurrence. So stents that have medicines in it that elute and prevent re-stenosis like we do in the heart. All those types of technologies are now being moved towards the brain. With respect to acute stroke where someone's having an, a stroke from a blood vessel thrombosis or, or occlusion, again, we're, advancing our technologies on when and what are the best times to do interventions such as thrombectomies, where we go up with catheters and actually pull out the clots or dissolve the clots.

In the realm of hemorrhage, obviously surgical decompression is required if there's a large hemorrhage. But we're seeing advancements in treatments with small hemorrhages where we're placing catheters that irrigate away the clots, so we're not having to do large surgeries. We're also seeing advancement in the treatment of an aneurysms or that rupture with coils and stents and flow diverters, in addition to our traditional surgery and traditional endovascular coiling.

And then the newest and latest kind of fad that we're seeing coming out of research models are the treatments of subdural hematomas, which are hemorrhages that occur on the surface underneath the skull, above the brain, often from a fall. Very common problems especially seen in the elderly.

And we're treating those now with a technique called meningeal artery embolization, where we go up with a catheter to the artery that feeds the, the dura, block it off, and that tends to decrease the, the, the formation and hasten the recollection of these subdural hematomas. And sometimes you don't have to go in and drain them.

So again, minimally invasive, less, traumatic to the actual brain itself. And seeing advancements in these types of conditions, hopefully, where we get to the point where we can not even have to do any invasive treatment whatsoever.

Host: And then how do these new treatments benefit the patient overall?

Anthony Alastra, MD: Well, obviously less is more when it comes to going inside your brain. Anytime you go inside the brain or the spine, you know, there's potential for damage, there's potential for injury, and there's potential for new problems such as seizures, that weren't there before. So if we can do things with less invasivity, treating the problem from a different approach as opposed to actually having to manipulate the brain or spine; you're going to seepatient benefits. So obviously less complications, less time in the hospital, hopefully less pain, disability and recovery time. So again, anything that can keep us from going into doing large procedures, will have benefits to the patient in multiple different facets.

Host: And wrap it up for us today, doctor. Are there measures that people can take to prevent these vascular diseases of the brain?

Anthony Alastra, MD: There are. First and foremost, if you're a smoker, we really would love to see you try to quit smoking. Smoking of course damages the blood vessels and of course can damage the blood vessels in the brain, and that can lead to both growth of aneurysms and or worsening of the atherosclerotic or hardening artery disease, both in the pre cerebral and the intercerebral vessels.

If you're a having high blood pressure, getting the high blood pressure under control is also very helpful. Obviously, again for the prevention of thrombosis of the arteries and the prevention of development of aneurysms.If you have diabetes or metabolic syndrome, you know, where you get basically have a combination of diabetes, high blood pressure, and high cholesterol; all of the treatments that help get those under control are going to be beneficial for the brain to prevent both hemorrhagic and ischemic stroke. And then lastly, if you have a family history of intracranial aneurysm, in a primary relative meaning like a brother, sister, father, son, not an indirect relative, like a, a spouse or a relative of a spouse.

If they have a history of an aneurysm, if there's more than one direct primary relative, we recommend the whole family, that genetic family be screened. That way, if you do end up having an aneurysm or a small aneurysm, one, we can follow it. And two, if it's large enough that it needs to be treated, we can treat it before it ruptures, which is a lot easier and a lot safer for the patient as opposed to having to deal with a, a rupture which could potentially be fatal. And so those are really the, the, the two biggest, components of, of pre vascular management that we can kind of control.

Host: Thank you, Dr. Alastra, for sharing your insights with us. For more detailed information, please visit eisenhowerhealth.org. If you enjoyed this podcast, please share it on your social channels and explore our podcast library for more topics of interest. I'm Caitlin Whyte, and you've been listening to Living Well with Eisenhower Health, healthcare as it should be.

Thanks for tuning in.