Stroke is the fourth leading cause of death in America and leading cause of adult disability.
While there have been remarkable advances in the treatment of heart attacks and various forms of cancer, stroke remains one of the last unsolved, potentially fatal diseases.
Long Beach Memorial’s Division of Interventional Neuroradiology in partnership with UCLA Health has led the way in using techniques to treat - and in some cases stop - stroke and aneurysms - from even happening.
More Than One Way to Treat a Stroke
Featured Speaker:
Satoshi Tateshima, M.D
Dr. Tateshima is actively involved in development projects of the world’s first intracranial stents specifically designed to treat aneurysms. He specializes in acute stroke interventions and aneurysm embolization using state-of-the-art, minimally invasive image-guided techniques to treat strokes and aneurysms. Transcription:
More Than One Way to Treat a Stroke
Deborah Howell (Host): Hello and welcome to our show. You are listening to weekly dose of wellness brought to you by Memorial Care Health System. I am Deborah Howell and today’s guest is Dr. Satoshi Tateshima, Interventional Neuroradiologist at Memorial Care Neuroscience Institute, Long Beach Memorial and Associate Professor Interventional Neuroradiology, University of California, Los Angeles. Welcome, Dr. Tateshima.
Dr. Satoshi Tateshima (Guest): Thank you, thank you very much for having me here.
Deborah: It’s all our pleasure. What does an interventional neuroradiologist specialised in?
Dr. Tateshima: It’s essentially specializes in any brain diseases. It is a catheter based very noninvasive or low invasive procedure, but because of its low invasive nature, it is very good to treat all kind of stroke patients like subarachnoid hemorrhage or any acute ischemic stroke.
Deborah: Okay, alright and why is an interventional neuroradiologist a critical part of the stroke team in hospitals.
Dr. Tateshima: Because the speed is the keyword here, in general a patient suffering from an acute ischemic stroke as a result of a blockage of a large brain artery, approximately 1.9 million neuron nerve cells die every minute and also more than close to 8 million of brain fibers are lost which means that every minute, they lose brain function, so we cannot really wait. We have to get to the lesion and we have to open that blockage to restore the flow to the downstream and for that, this low invasive and very quick access to the brain plays a significant role.
Deborah: Okay, as they say time is brain, is that correct?
Dr. Tateshima: Yes, that’s correct.
Deborah: Okay, so for many years, surgery was the only treatment available for many conditions such as stroke. Today, interventional radiology treatments provide another less invasive option for treating stroke and also aneurysms, so can you explain the additional options for treatment.
Dr. Tateshima: Additional options before interventional procedure became available to us are essentially two options, one is a medical management. We just do nothing or just try to manage like say patient with brain aneurysm, try to reduce risk factors like cigarette smoking or maintain blood pressure or things like that, that is one option and another option was the surgery, both in the skull, dissect the brain and get to the lesion and there is aneurysm, we clip it and if there is a blockage, surgically remove it with a bypass surgery, thus there were two options and they still are very important options and we have to provide those options to the patients and in late 90s, interventional procedure became available to us and to the patients and now that’s also a very valuable option because the patients suffering from additional diseases like a lot of comorbidities, they may not be a good candidate for open surgery and in some condition, it is severe enough not to be treated by medical management and then interventional procedure may be the only option for them.
Deborah: Okay, now how are these techniques less invasive than traditional surgery methods.
Dr. Tateshima: It is a catheter-based procedure, so we know that was to get to the brain. We don’t have to dissect the brain. We don’t have to remove or dissect, essentially brain environment is preserved. We get to the brain via arteries or veins, so we don’t leave any scar in the brain that’s what makes this very less invasive.
Deborah: Absolutely, of course and who would be an ideal candidate for interventional treatment?
Dr. Tateshima: Essentially everybody if there is, you know, right indication, anatomy permits, we can virtually treat everybody, but this low invasive procedure is particularly ideal for patient with a lot of comorbidities or who cannot be a good surgical candidate such as older patients. Interventional procedure may be only available options for them.
Deborah: I see okay. Now if a person has a brain aneurysm and is a candidate for interventional treatment, how would the division of interventional neuroradiology team treat it?
Dr. Tateshima: There are many ways to treat and depending on the size of the aneurysm and the location and its presentation, we select the best treatment, but we primarily use soft platinum coils to pack the brain aneurysm so that it is isolated from the systemic circulation and the aneurysm is thus protected and sometimes the disease or aneurysm is too large or damage is not just the small area, it may be very extensive and the artery cannot be repaired, in that case we have to use a stent that’s a metal mesh and we can reconstruct the whole brain arteries including aneurysm, so depending on the condition, we can provide variety of treatment options to all the patients.
Deborah: I hadn’t realized that stents are still made of, what did you say exactly?
Dr. Tateshima: Metal, like a nitinol, some stents are made of nitinol that’s shape memory alloy and some stents are made out of cobalt chromium.
Deborah: Really, for some reason I thought we gone to the plastic side, but.
Dr. Tateshima: That’s yes and polymer stents that’s available, but in the brain, the problem of a polymer stent is that, you know, particularly some like bioabsorbable stents that’s now available in the other part of the body, but the problem is any small fragments that may be created from those polymer or bioerodible absorbable stents that may fly downstream and that may cause a stroke in the brain and the brain carries, you know, very significant roles. Each part of the brain carries a very significant role, so we don’t want to have any downstream coming out of a stent, so we still use old metal and that’s the status so far.
Deborah: That’s very interesting to me. What else should we know about your profession and your specific duties that you have as a neuroradiologist?
Dr. Tateshima: A neuroradiologist, this is actually a very overlapping field, so although we call this interventional neuroradiology, people sometimes call this endovascular neurosurgery or interventional neurology or interventional surgical neuroradiology, people call this specialty many ways because we can have a very wide range of diseases and sometimes, it may not be right for us, but still we are more than happy to see, you know, those patients because we can refer those patients to appropriate services such as open neurosurgery or you know radiosurgery or neurology or neurorehabilitation, things like that, so virtually we see all patients.
Deborah: Okay, it sounds like you are a man who really loves what you do.
Dr. Tateshima: Yes, you know this is, I unfortunately, of course, and have to see sad cases, you know, patients suffering from stroke, I feel really bad, but we really enjoy saving our patients and also what we enjoy here is we unfortunately cannot really treat all patients and we cannot really save all of them, but we learned a lot and we are trying to advance our field and improve our device and treatment methodology, that’s our research and we are committed not just to do clinical cases, but also research to improve the patient care.
Deborah: And you learn with every case, right.
Dr. Tateshima: Yes, I am still learning, I have been doing this for like 10 years, but yes everyday I am still learning.
Deborah: From the first day you started doing these procedures to today say 10 years, what’s the scope of the change for a patient?
Dr. Tateshima: The scope on the change, I am sorry what meaning?
Deborah: Meaning, how is it different, how are the outcomes different, how is the treatment hard on the body 10 years ago compared to now, it’s got to be much easier.
Dr. Tateshima: Yes and that’s a great question, may be 10 years ago, many devices were still difficult to use for certain neurointerventionalist, but now devices are much better, so that made our procedure safer and also less actually operator dependent, less operator skill dependent, so you know certain very difficult conditions, you know, very experienced operator can provide better, you know, outcome to the patient that’s the fact, but let’s say acute stroke, we cannot have very experienced operator always available 24x7, so if a device enables even relatively inexperienced operator to achieve a very good success rate and outcome, that’s ideal and that’s what’s happening now, all devices are very easy to use and they are very efficacious and they provide us a very good result.
Deborah: And that is very good news indeed. I do have one final question, if someone is interested in getting more information on the stroke program and the division of interventional neuroradiology at Long Beach Memorial, who can they call?
Dr. Tateshima: The number is 562-933-4006, that’s Andrew West, she is our stroke director and if needed, she can direct the line to neurosurgery and interventional radiology or neurology to the appropriate contact person.
Deborah: Beautiful, thank you so-so much Dr. Tateshima for all your information today.
Dr. Tateshima: Thank you very much.
Deborah: It has been a pleasure having you on the program today and if you would like to listen to the podcast or for more info, please visit memorialcare.org. I am Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by Memorial Care Health System. Get out there and have a fantastic day.
More Than One Way to Treat a Stroke
Deborah Howell (Host): Hello and welcome to our show. You are listening to weekly dose of wellness brought to you by Memorial Care Health System. I am Deborah Howell and today’s guest is Dr. Satoshi Tateshima, Interventional Neuroradiologist at Memorial Care Neuroscience Institute, Long Beach Memorial and Associate Professor Interventional Neuroradiology, University of California, Los Angeles. Welcome, Dr. Tateshima.
Dr. Satoshi Tateshima (Guest): Thank you, thank you very much for having me here.
Deborah: It’s all our pleasure. What does an interventional neuroradiologist specialised in?
Dr. Tateshima: It’s essentially specializes in any brain diseases. It is a catheter based very noninvasive or low invasive procedure, but because of its low invasive nature, it is very good to treat all kind of stroke patients like subarachnoid hemorrhage or any acute ischemic stroke.
Deborah: Okay, alright and why is an interventional neuroradiologist a critical part of the stroke team in hospitals.
Dr. Tateshima: Because the speed is the keyword here, in general a patient suffering from an acute ischemic stroke as a result of a blockage of a large brain artery, approximately 1.9 million neuron nerve cells die every minute and also more than close to 8 million of brain fibers are lost which means that every minute, they lose brain function, so we cannot really wait. We have to get to the lesion and we have to open that blockage to restore the flow to the downstream and for that, this low invasive and very quick access to the brain plays a significant role.
Deborah: Okay, as they say time is brain, is that correct?
Dr. Tateshima: Yes, that’s correct.
Deborah: Okay, so for many years, surgery was the only treatment available for many conditions such as stroke. Today, interventional radiology treatments provide another less invasive option for treating stroke and also aneurysms, so can you explain the additional options for treatment.
Dr. Tateshima: Additional options before interventional procedure became available to us are essentially two options, one is a medical management. We just do nothing or just try to manage like say patient with brain aneurysm, try to reduce risk factors like cigarette smoking or maintain blood pressure or things like that, that is one option and another option was the surgery, both in the skull, dissect the brain and get to the lesion and there is aneurysm, we clip it and if there is a blockage, surgically remove it with a bypass surgery, thus there were two options and they still are very important options and we have to provide those options to the patients and in late 90s, interventional procedure became available to us and to the patients and now that’s also a very valuable option because the patients suffering from additional diseases like a lot of comorbidities, they may not be a good candidate for open surgery and in some condition, it is severe enough not to be treated by medical management and then interventional procedure may be the only option for them.
Deborah: Okay, now how are these techniques less invasive than traditional surgery methods.
Dr. Tateshima: It is a catheter-based procedure, so we know that was to get to the brain. We don’t have to dissect the brain. We don’t have to remove or dissect, essentially brain environment is preserved. We get to the brain via arteries or veins, so we don’t leave any scar in the brain that’s what makes this very less invasive.
Deborah: Absolutely, of course and who would be an ideal candidate for interventional treatment?
Dr. Tateshima: Essentially everybody if there is, you know, right indication, anatomy permits, we can virtually treat everybody, but this low invasive procedure is particularly ideal for patient with a lot of comorbidities or who cannot be a good surgical candidate such as older patients. Interventional procedure may be only available options for them.
Deborah: I see okay. Now if a person has a brain aneurysm and is a candidate for interventional treatment, how would the division of interventional neuroradiology team treat it?
Dr. Tateshima: There are many ways to treat and depending on the size of the aneurysm and the location and its presentation, we select the best treatment, but we primarily use soft platinum coils to pack the brain aneurysm so that it is isolated from the systemic circulation and the aneurysm is thus protected and sometimes the disease or aneurysm is too large or damage is not just the small area, it may be very extensive and the artery cannot be repaired, in that case we have to use a stent that’s a metal mesh and we can reconstruct the whole brain arteries including aneurysm, so depending on the condition, we can provide variety of treatment options to all the patients.
Deborah: I hadn’t realized that stents are still made of, what did you say exactly?
Dr. Tateshima: Metal, like a nitinol, some stents are made of nitinol that’s shape memory alloy and some stents are made out of cobalt chromium.
Deborah: Really, for some reason I thought we gone to the plastic side, but.
Dr. Tateshima: That’s yes and polymer stents that’s available, but in the brain, the problem of a polymer stent is that, you know, particularly some like bioabsorbable stents that’s now available in the other part of the body, but the problem is any small fragments that may be created from those polymer or bioerodible absorbable stents that may fly downstream and that may cause a stroke in the brain and the brain carries, you know, very significant roles. Each part of the brain carries a very significant role, so we don’t want to have any downstream coming out of a stent, so we still use old metal and that’s the status so far.
Deborah: That’s very interesting to me. What else should we know about your profession and your specific duties that you have as a neuroradiologist?
Dr. Tateshima: A neuroradiologist, this is actually a very overlapping field, so although we call this interventional neuroradiology, people sometimes call this endovascular neurosurgery or interventional neurology or interventional surgical neuroradiology, people call this specialty many ways because we can have a very wide range of diseases and sometimes, it may not be right for us, but still we are more than happy to see, you know, those patients because we can refer those patients to appropriate services such as open neurosurgery or you know radiosurgery or neurology or neurorehabilitation, things like that, so virtually we see all patients.
Deborah: Okay, it sounds like you are a man who really loves what you do.
Dr. Tateshima: Yes, you know this is, I unfortunately, of course, and have to see sad cases, you know, patients suffering from stroke, I feel really bad, but we really enjoy saving our patients and also what we enjoy here is we unfortunately cannot really treat all patients and we cannot really save all of them, but we learned a lot and we are trying to advance our field and improve our device and treatment methodology, that’s our research and we are committed not just to do clinical cases, but also research to improve the patient care.
Deborah: And you learn with every case, right.
Dr. Tateshima: Yes, I am still learning, I have been doing this for like 10 years, but yes everyday I am still learning.
Deborah: From the first day you started doing these procedures to today say 10 years, what’s the scope of the change for a patient?
Dr. Tateshima: The scope on the change, I am sorry what meaning?
Deborah: Meaning, how is it different, how are the outcomes different, how is the treatment hard on the body 10 years ago compared to now, it’s got to be much easier.
Dr. Tateshima: Yes and that’s a great question, may be 10 years ago, many devices were still difficult to use for certain neurointerventionalist, but now devices are much better, so that made our procedure safer and also less actually operator dependent, less operator skill dependent, so you know certain very difficult conditions, you know, very experienced operator can provide better, you know, outcome to the patient that’s the fact, but let’s say acute stroke, we cannot have very experienced operator always available 24x7, so if a device enables even relatively inexperienced operator to achieve a very good success rate and outcome, that’s ideal and that’s what’s happening now, all devices are very easy to use and they are very efficacious and they provide us a very good result.
Deborah: And that is very good news indeed. I do have one final question, if someone is interested in getting more information on the stroke program and the division of interventional neuroradiology at Long Beach Memorial, who can they call?
Dr. Tateshima: The number is 562-933-4006, that’s Andrew West, she is our stroke director and if needed, she can direct the line to neurosurgery and interventional radiology or neurology to the appropriate contact person.
Deborah: Beautiful, thank you so-so much Dr. Tateshima for all your information today.
Dr. Tateshima: Thank you very much.
Deborah: It has been a pleasure having you on the program today and if you would like to listen to the podcast or for more info, please visit memorialcare.org. I am Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by Memorial Care Health System. Get out there and have a fantastic day.