Gabby Cinnamon (Host): Welcome back to Well Within Reach, brought to you by Riverside Healthcare. I'm your host, Gabby Cinnamon. And today, I'm very excited to be joined by Riverside neurosurgeon, Dr. Jehad Zakaria, to talk about the advanced stroke and neurosurgeries he is bringing to our community.

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Host: Thank you so much for coming on the podcast today, Dr. Zakaria. So, this is your second podcast with us. Can you tell us a little about yourself and your background and kind of remind everyone who you are?

Jehad Zakaria: Yeah, absolutely. Thanks for having me. It's really exciting to be back here for another one of these. I think the last one we talked about brain tumors, if I remember correctly. It's been a little bit of time. So, yeah, I trained at Loyola Neurosurgery in 2022, and I've always had an interest really in Cranial and Vascular Neurosurgery. I think I first arrived here, I was really happy to be taking care of patients in terms of their hemorrhagic strokes in terms of traumas and brain tumors and the like.

But one thing we did not have the capacity to do was endovascular interventions. And what that means is going through the groin or the wrist with little catheters up to the neck and to the brain and studying the vasculature that way and doing potential interventions as needed. So, I've gone to train at the University of Chicago just over the past year and have brought this back. We'll be starting here fairly soon to be able to provide that service to the community.

. You know, because there's a couple of components to this, like we've talked about, can you talk about the stroke component? What now will we be able to do here at Riverside that previously people would have had to go up North for or South for?

Jehad Zakaria: Of course! So, as you know, and I think we may have touched on this in previous discussions, not podcasts, but lectures and discussions with various members of the community, stroke is a very large catchment phrase. A lot of it is hemorrhagic. That is people that have a neurologic deficit because of bleeding in the brain. And that is, of course, the component where there's a neurologic deficit from an ischemic event. That is, blood doesn't get to the right part of the brain or doesn't get there in time.

So, of the different subsets of stroke, the ischemic stroke has different categories where over the past decade or so and much more has been evident since then, we can actually do interventions to, in select patients, open up the arteries to the brain and allow that reperfusion, we call it, where the brain, if there's a blood vessel that's clogged, essentially, we can open that up again in select cases and allow the brain of that particular patient to be reperfused or to get the blood supply that it needs.

And depending on how things go, for the vast majority of the time, there's something called number needed to treatment. When we do enough of these, you'll see that, in general, patients that have these interventions at the three months and six months and one year are better off having had that procedure done than not.

So, we are already a stroke center. We're already a primary stroke center here at Riverside. What we're bringing in over the next few months is the endovascular capability. So, we'll be able to do already all the triaging that we do. All the medical management of stroke that is hemorrhagic or ischemic non-interventional that we already do. We'll expand on that by being able to provide the intervention itself if needed for these patients. So, we'll be able to do that here as well. So if patients come in, they have a stroke, and it ends up being one of these where, previously, they would have to be transferred to one of the other partner facilities in Chicago, we can do this here now.

Host: Awesome. That's all very exciting and a huge deal to have this in the community.

Jehad Zakaria: Absolutely.

Host: Yeah. Can you talk a little bit more about why having stroke care in our community is so important and kind of the time aspect of why that makes a huge difference for patients?

Jehad Zakaria: Of course, of course. So in general, neurologic deficit, we think of it as something that once it's set, it's hard to reverse. Our roles really are to diagnose it early and do interventions if needed to make sure that the neurologic damage does not progress. And whatever damage has happened already, it stays the same. And of course, patients can have some recovery thereafter. So, the role here, and in a case where we do reperfusion, it's really very similar in concept to heart attacks and what they called STEMIs, where the cardiologists and different team members would go in and open up an artery to allow a part of the heart to reperfuse. It doesn't mean that the patient did not have an MI, did not have a heart attack. And in this case, it wouldn't mean that the patient did not have a stroke, but if the effect of that stroke would be less on the, say, cardiac tissue and in this case would be on the brain, and allow them for a better recovery in the future.

So with things like this, time matters quite a bit. So, as they say, time is brain. And as you know, the cardiac interventions are done on an emergency basis. So, this is the same because we're very good at making sure that things don't worsen over time. Once we diagnose them and put a pause or a stop to that insult, we call it. So, being able to do these in a short order in an emergency setting allows us to make sure that whatever damage has happened stays the same and doesn't progress. That's why having a stroke center and everything lined up in a very efficient triaged way and we'll see this nationally, and we're able to do this here at Riverside, allows us to kind of push patients through, if you would, the pipeline to make sure that the ones that have had damage done, we make sure that they have additional prevention where no additional damage happens, all the risk factors are optimized. And then, the ones that are potential candidates for an intervention, we do that to make sure that the brain damage gets stopped. And then, we don't get additional damage.

And of course, they go on to have additional workup and making sure that the risk factors are controlled, minimizing the risk of having yet an additional stroke in the future. So, time is really important. And having this in the community, patients generally for good quality care, they'll go anywhere. It's really important. So, it's not just the geography, it's being able to provide excellent quality care here in town. So, if they have the option of having their care done here in their community hospital in an excellent fashion versus having to go elsewhere, I think they prefer getting this done here. But of course, the emphasis is on quality and that has been us being able to deliver the standard of care locally.

Host: For sure, for sure. Now, moving on to the elective side and, you know, you really wouldn't think people would elect to have brain surgery but kind of in the sense of not, okay, you didn't come through the emergency room and you're not having a stroke, but you will be able to provide advanced neurosurgery for those patients who, you know, it's not an emergent event. Can you talk about the conditions that you'll now be able to help people with that we were not able to before with these new procedures you're bringing here?

Jehad Zakaria: Of course. So, the endovascular, so there's one component about cranial neurosurgery that we already do with advanced imaging protocols and just being able to minimally invasively or sometimes less so being able to manage different tumors, different hemorrhagic issues that patients have in the form of brain surgery. And some of it is urgent, as we had discussed, but other components are what we generally call elective. But, you know, people generally don't elect to have brain surgery. When the options are presented to them, most people will make an informed decision, i.e., elect to have a procedure that's going to save their life or improve their neurologic function in the long run. So, we do continue to do these.

What having endovascular capabilities will allow us to do here, in an elective fashion, if you would, would be to treat lots of different things including arteriovenous malformations or AVMs in the brain, aneurysms in the brain, carotid procedures and stents in the neck that goes to the brain and just being able also too-- there's a diagnostic component to that technology and it's just doing a formal, they call it a catheter angiogram, where we get the gold standard images of the vasculature in the brain. So, stroke is one aspect of all of this. That's kind of the emerging component and we're more than happy to provide that care here, but there are also other ones that are less emergent, but equally important. Aneurysms that rupture, for example, these are not true emergencies, they're urgent, they're not elective, but we can treat these aneurysms and secure a rupture point in an aneurysm through the endovascular route. So again, going through the vessel, with little catheters through the wrist or the groin and making sure that that aneurysm is either coiled or stented or web devised or whatever it may be so that the patient is no longer at risk of re-bleeding. And for an aneurysm that has not ruptured but came about when a patient had, say, an incidental finding, sometimes people will have headaches, or they have an image for, say, a tumor or something like that, or they just have a car crash, and they're doing fine, but they end up imaging the brain. And in these cases, we discover that they have an aneurysm, and it's an unruptured aneurysm, and there are different criteria. We meet in the office. These are not emergencies. We meet in the office, and I already have a few of these patients discuss all the options for whether or not an aneurysm even needs to be surveyed, whether it needs to be treated. Again, the select patients for whom the consensus between myself, other neurologists, and other members of the team, and most importantly, the family members, the patient and his or her family, when we reach a consensus that a treatment is an option, then we can go ahead and provide that service through the catheter in a minimally invasive way.

Host: Yeah, no, that makes sense. I think that's good to point out because, you know, people do associate aneurysm, emergency, you know, brain surgery, emergency. And not everything, like you said, is an emergency. So, that's also very important that we have care for those things here too. So, can you kind of talk about why Riverside decided to invest in bringing this care to our community? There was a lot of technology that had to be purchased. It is a huge investment. And it's awesome to have this here. And can you kind of talk about what went into that and why Riverside decided to bring this here?

Jehad Zakaria: Absolutely. So, Riverside is a community hospital. And I think really at their core, they're here to serve the community. This is a community service, so this is a service that's advanced neurosurgical and neurologic technology for interventions that any community would need. It's like saying, "Well, you're a hospital that doesn't provide cardiac care," right? So, this is kind of the next line in terms of us being able to provide comprehensive neurosurgical and neurologic management and interventions here.

And I brought up the idea to my partner, Dr. Jimenez and the administration. And from really very early on, they were quite receptive because again, at their core, they're a community hospital that is here to serve the community. And I think when we brought up an idea, this is not equipment for me or even for the hospital, it's something that we need to be able to provide excellent care to the community and provide yet another service and expand.

So, it's almost why would they not, right? It's an automatic kind of a no-brainer. But of course, it's a big investment and these kinds of projects take a lot of planning and I think everybody's really on board with the aim in mind of building something that lives in the community for the patients, for the community. So there's really very little convincing that we had to do because again, the mission statement is a natural progression of us being able to provide these services here to the community.

Host: Right. No, that's awesome. So, you went back and got a fellowship to be able to provide this care. Can you talk about what made you decide to do that? Because you're going to be kind of the main provider doing this now, maybe, you know, we'll get more in the future. But right now, you know, you're going to be able to do this. What made you decide to go back and do that, especially, you know, after going through all that school and everything? Can you kind of talk about why you decided to take the initiative and bring this here?

Jehad Zakaria: So for me personally, it's just a personal interest has always been there. If you look at Neurosurgery maybe 10, 15 years ago, doing catheter work was probably not that prominent role in it. But the future is already here. The catheters are the way to go. There's really not a huge discussion over this anymore. Some centers are still doing open surgery for aneurysms and AVMs. And I think that's reasonable. Select cases will be able to do that. But for me, it's to be able to provide comprehensive care for supravascular disease, which you know, that's one of the things that I'm super interested in.

Neurosurgery is quite varied and wide, as you know. You can have quite a bit of overlap with a lot of different specialties, but the part of neurosurgery that interests me personally is cranial neurosurgery for tumors and skull-based procedures, as well as supravascular neurosurgery. In the open section, at least, there's a strong overlap. But I've always had an interest in making sure that I have comprehensive training to be able to provide care in a comprehensive fashion. You don't want a patient to show up to your office and say, "Well, listen, I got an aneurysm. What are the options?" And you say, "Well, listen, the only options I can give you, I can cut open your head." and sometimes that is the best option, honestly, depending on the situation, if they have a large tumor or they have a bleeding in the brain that needs to be stopped or evacuated. But oftentimes that, patients prefer other treatments that may be minimally invasive, although they do have some caveats that have to be considered in of that longevity of that treatment and other things.

So I wanted to be able to provide comprehensive care. When a patient comes in, I offer them all the options. I offer them also my recommendation or my opinion, what I think is reasonable or unreasonable. And then, they make a decision and I share with them kind of my comfort level with all of these and what I would, for my family, get done.

So, I think, although neurosurgical training is very long, for us, I mean, if you want to do this aspect of Neurosurgery, you really just have to be fully trained. The people that trained me, you know, not all of them, the older generation were kind of grandfathered in, if you would, to doing aneurysms and doing tumors and things like this. The modern neurosurgeon has to be specialized, and I think that's really the standard of care. And for me, it was always a natural progression of what I wanted to do.

Host: Awesome. Well, you know, the community is going to be very grateful to have this here, for sure. It's going to make a huge difference, and this is awesome that we're going to be able to do this. So, is there anything else you would like to add, you know, that we haven't covered that you would like to talk about?

Jehad Zakaria: No, I really appreciate the opportunity to be in the community. And, you know, the administration has been quite supportive. My partner is Dr. Jimenez. Specifically, he's been on top of this, kind of whatever I wanted. I never asked for expensive things. But really, from the very beginning, I think he saw that there's a potential opportunity for us to grow as a group and to be able to provide additional services, advanced services to the community, and we're all kind of moving ahead in that direction.

So, I'm fairly excited. I'm also very excited not to be driving in Chicago every day. So, you know, I think the future is very bright. And I live here in Bourbonnais. And I used to live in Chicago for a long time. I lived all over the country in big cities and small cities. Living in a small town is fine. I'm actually a very boring person, but the key thing is just because you decide or you are from a small community or you live in a small town, it doesn't mean that when it's time to get medical care that you should kind of be handed the short end of a stick, you know, standard of care, standard of care, wherever you may be, that needs to be done.

So, I like living here, I like the community. I think this is a great potential for us here. You know, I wanted to make sure that patients, when I counsel them, it's as if they're at an academic center anywhere else in the country. They're really getting all the options. I think what I would want for my family.

Host: Awesome. Well that's a great place to end off on. Thank you so much for coming on the podcast today. We really appreciate it.

Jehad Zakaria: Anytime. Thank you for having me.

Host: And thank you listeners for tuning in to Well Within Reach, brought to you by Riverside Healthcare. For more information about stroke care and neurosurgery at Riverside, visit riversidehealthcare.org. Also, make sure to rate and leave a review for well within Reach on Apple, Spotify, or wherever you listen to podcasts.