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Bob Lewis (Host): Hey, welcome to our continuing series on the Advice Line with the folks from Summa Health about the services provided there, and the doctors that work there in providing excellent health care to people in our area.

Summa Health has an award winning Stroke Care Program we're going to talk about today. Innovative pre treatments for patients who suffer from strokes or aneurysms. Our expert is Dr. Alexander Venizelos. He is the Medical Director for the Neuro Endovascular Surgery at Summa Health Neuroscience Institute here in Akron.

His special interests include neuro interventional surgery, ischemic and hemorrhagic stroke, pre surgical tumor embolization of brain and spine, vascular disorders of the head, brain, and spine, including cerebral aneurysms, subarachnoid hemorrhage, cerebrovascular atherosclerotic disease and dissection, arterial venous malformations, fistulas of the brain and spine, refractory epistaxis.

While these are kind of mouthfuls to say, and some people may find them very odd terms, I bet there are more than a few of you out there who have either yourself or a loved one who has suffered from one of those conditions. Dr. Venizelos attended medical school at Wright State University, Boonshoft School of Medicine in Dayton.

He had his residency at Loyola University of Chicago Stritch School of Medicine in Chicago and completed his fellowship at Chicago's Rush University Medical Center in Neurological Care as well as the Texas Stroke Institute in Endovascular Surgical Neuroradiology. So, Doctor, thanks for coming on the program today and taking time out of your day.

Alexander Venizelos, MD: Yeah, Bob, no, thank you for having me. I'm happy to be here.

Host: Now, we're going to talk, of course, about, about stroke, and we heard a lot of medical terms there when I read your biography. Can you kind of explain to our listeners what a neurovascular surgeon specializes in?

Alexander Venizelos, MD: Yeah, absolutely. Um, so basically I, I specialize in any blood vessels that are above the clavicle, um, that go to the head, the neck, the brain. Um, what I do in particular is, uh, we use minimally invasive techniques. So access either through the wrist or through the groin region, one of the blood vessels, and we can float wires and catheters throughout the body, uh, and use x rays, uh, with our wires and catheters in the bottom of the neck to get very detailed pictures of the blood vessels that supply the face, that supply the brain.

And so basically what I do then is, uh, for diagnostic purposes, we could take pictures of any abnormality in a blood vessel above the neck. Um, and if we have to, if there's a blockage or a vessel that is leaking, causing a stroke, we could advance our catheters and fix whatever problems, uh, that are there with this minimally invasive technique.

So the way I think about it is minimally invasive neurosurgery for the spine, the brain, and the head.

Host: Doctor, can you tell us the difference between a stroke and an aneurysm?

Alexander Venizelos, MD: Yes, uh, that's a great question. Stroke is really an umbrella term. Um, so stroke includes what we call ischemic or hemorrhagic. So an ischemic stroke is a normal type of stroke you typically hear about in your friends and family. It's where a blood vessel is blocked and there's lack of blood flow to certain areas of the head, the neck, or the brain. Where if there's an outpouching or an aneurysm, that can sometimes cause what we call a hemorrhagic stroke, where there's bleeding or leaking of blood into the areas of the brain or surrounding the brain tissue.

Host: Now what usually causes these neurological conditions?

Alexander Venizelos, MD: We think, um, of, uh, risk factors in people as modifiable and non modifiable. So there are things we can change and there are things we can't change. So modifiable risk factors, things we advise our patients not to do or to try to change in their life, are things like smoking, diet, exercise, how we manage our medical conditions.

So there are things we can't change, like our age, our genetics, our family history, um, whether or not we've already had a stroke, and certain other factors that we can't modify or change. So what we really focus on are things that slow down blood vessel disease, both for the heart and for the brain.

Things like smoking, things like low salt. The American Heart Association recommends exercise at least 30 minutes on as many days as you can tolerate. Uh, and, and those sorts of things.

Host: Now, when you're talking about these risk factors like age, what, how does age figure as a risk factor?

Alexander Venizelos, MD: So as we get older, um, the blood pressure and the, uh, cholesterol inside of our blood vessels, uh, can cause those blood vessels to, um, develop plaques or atherosclerosis.

Those plaques can cause narrowing in the heart or in the blood vessels going to the brain, and it can also cause turbulence of blood flow. So as we get older, um, these vessels get more tortuous, more windy, um, and then they can have small little irregularities, plaques, and those plaques can, um, cause, uh, flow to be disrupted and cause clots to form, or even in some cases, they can break off and travel to the heart or the brain or other structures of the body, and that can cause damage to those structures.

Host: So what are the common symptoms that people should know to look for when, uh, somebody would be having a stroke or an aneurysm before them?

Alexander Venizelos, MD: So anything sudden or severe is something we tell patients to be really careful about. We talk about an acronym called BE FAST, and that stands for B is for balance, any sudden issues with balance, the E is eyes, so any abnormalities in your vision or eye movement or double vision, anything sudden and severe, the F is for face, so if the side of your face is drooping, or irregular.

The A is for arm, so if one arm falls down. S stands for speech, any slurred speech or speaking difficulties. And then T stands for time. That means if you have any of those symptoms, react very quickly and call 911 as soon as possible. So, that's kind of how we advise patients to think about the acronym BE FAST.

If we see any of those symptoms, if we observe a loved one having any of those symptoms. Really try to call 911 or seek medical attention as quickly as possible. One more additional thing, so that's the ischemic side of the strokes, but sometimes if patients have the hemorrhage that we discussed, they can develop a sudden or severe headache.

So headaches are pretty common, but if anything comes on very, very quickly or is very severe, in addition to any of those symptoms I mentioned, um, that would, you know, trigger somebody to want to seek very quick medical attention because there are things we can do early on that we can't really do later in the course of a stroke.

Host: Can a stroke be brought on by, let's say, excessive physical activity or, you know, somebody losing their temper and getting very upset? Can it bring on a stroke?

Alexander Venizelos, MD: Yeah, absolutely. We talk about, um, um, that a lot. Anything that can elevate the blood pressure, or cause changes in the heart rhythm, or the beating of the heart, um, or can elevate the blood pressure in the head, or the blood vessels going to the head, can precipitate a stroke. So a lot of times, you know, especially this time of the year, uh, even with the good weather we're having, we have patients that are shoveling their driveway or, uh, doing other kind of strenuous activities. And sometimes that can precipitate somebody, um, having a stroke or a, a plaque breaking off and causing a problem.

Host: So how are these specific conditions diagnosed once the person has these symptoms?

Alexander Venizelos, MD: That is, that is another good question. We use very rapid imaging techniques when patients arrive to the hospital to see if there's any major abnormalities on CT scans, MRIs. The procedure that I do is called Cerebral Angiography.

Um, that is where we use computers and x-rays to look at the blood vessels and use catheters inside them. But when somebody comes to the ED, we use very simple, very rapid imaging techniques for any bleeds or any strokes or anything else that might, uh, might be able to be treated very quickly in the emergency room.

Host: Now, of course, we hear there are many advancements recently in these treatments of stroke and aneurysm. What are some of the most recent advancements that you can find most exciting?

Alexander Venizelos, MD: Well, what I find most exciting is, is, is what I do. So actually, the procedures we're talking about today, um, are fairly new in the past 15 or 20 years. The techniques and the, the tools that we use to push wires and catheters and other devices inside the body are constantly changing.

So that, um, that, this minimally invasive surgical technique is constantly changing over time. Um, we also use a lot of, uh, robots and telemedicine and we can beam into patient's rooms and do exams and pull up different things and interact with different patients in different ways through computers and through telemedicine in our hospital.

Um, you know, the combination of those two things, um, uh, is in our neurointervention or our radiology suite for neurointervention and Summa has just built a brand new whole interventional radiology suite that patients can come and get the most recent advances in these types of therapies and these types of techniques to help us interact with patients.

Host: Now some of the other terms that we talked about earlier, what is a fistula of a brain and a sporespine?

Alexander Venizelos, MD: So, a fistula or an AVM, uh, we're talking about, um, arterial venous malformations or any abnormal connections. So, a fistulous connection is an abnormal connection usually between an artery and a vein and sometimes there can be a tangle of blood vessels in between.

So those fistulas can expose veins, which are very weak walled vessels, under very high pressures. So, arteries, if, you know, an artery's, uh, uh a very strong, thick hose, and it's connected to a very weak blood vessel through an abnormal connection; you're exposing that weak blood vessel to very high pressures, and those can bleed, those can cause seizures, they can cause other symptoms in patients.

So that's where we talk about arteriovenous malformations and fistulas, or fistulous connections between those different blood vessels.

Host: Now, tumors. We talked about tumor embolization of brain and spine. Are all tumors of that area, are they all going to be cancerous tumors?

Alexander Venizelos, MD: Not necessarily. There's some very benign tumors. Um, and even benign tumors can enlarge to a size that they cause problems. So sometimes they can cause seizures, or they can cause pressure on the outside of the brain, and they can be symptomatic. So even tumors that are very benign sometimes need treatment. And what we can do is we help out neurosurgeons by, uh, if they need to go in and remove a tumor that may or may not be very vascular.

So they go in and they do their procedures. And historically, these procedures have led to a lot of blood loss or a lot of complications. We can go in ahead of time and cut off certain types of blood supply to whatever the problem is that the neurosurgeon is then going to remove. And we can make those procedures much easier, much simpler and much safer. So in addition to doing our own treatments and our novel treatments for certain types of strokes and vascular disease, we can actually assist in other neurosurgical and spine procedures as well.

Host: Now the effects of a stroke, of course, it can be devastating as we know, including death, but what about the rehabilitation from a stroke? How are we, is our science working now with getting people trying to get them back to as much of an activity as they had before?

Alexander Venizelos, MD: That's a good question because stroke is not the number one leading cause of death, but it is the number one leading cause of disability in our, in our, um, in our society.

So, um, there are a lot of advancements in the rehabilitation of stroke. The brain, we're finding, can be a very plastic organ. So, if we can, um, get patients you know, the minimal amount of brain damage with some of these treatments up front in the acute time period, and we can rehabilitate them. We have a brand new rehabilitation center that specializes in kind of exoskeletons.

They can use different types of techniques in computers. Um, sometimes there's even, you know, visual reality where you can put, you know, these big machines over patients eyes and small movements can mimic kind of big movements inside their brains and in their heads and really focus on improvement. Um, and we are using a lot of these different types of advanced techniques to rehabilitate patients after their strokes in addition to treating them up front.

Host: Now, is there any indication that gender plays a factor in their susceptibility to a stroke or an aneurysm?

Alexander Venizelos, MD: It goes back and forth. Um, you know, uh, women have a little bit of a longer lifespan, uh, in the U.S. right now than men do. Um, and then certain types of risk factors like gender, we're always looking into, um, you know, what's more likely to, to be susceptible to stroke, um, and it has changed slightly over the years with things equating out between the two genders.

But you know, in any, in any gender, uh, it's very important to focus on the things I mentioned like exercise, diet, controlling your, your medical issues like hypertension, diabetes, high cholesterol, all those things kind of combined have an effect, um, into, uh, treatment of stroke and into stroke, uh, how frequent it is.

So, we kind of look at all those factors, uh, when we're, we're treating stroke patients.

Host: You talk about the risk like high blood pressure. What is the current feeling about what the normal blood pressure should be for adults?

Alexander Venizelos, MD: So, uh, you know, it depends, because people's blood pressure fluctuates throughout the day. Uh, the number, over the years, we've gotten even more strict, um, when we're looking at that top and the bottom number for how high we can tolerate it. So as you check your blood pressure throughout the day, we really like that top number or the systolic blood pressure to be less than 120, kind of pretty frequently and regularly throughout the day.

We also don't want things to be too low. So, you know, obviously see your doctor, uh, to have blood pressure, you know, medications managed, um, and stay well hydrated is also very helpful to reduce your risk of stroke. But that number, the top number, 120, is something we want to shoot for or shoot below when we're talking about cardiovascular and stroke risk reduction.

Host: Are we talking about a number that at rest, or are we talking about a number uh, during activities, or where are we supposed to take that blood pressure reading?

Alexander Venizelos, MD: That's at rest, um, sitting kind of calmly, um, you know, without a lot of pressure. Because our, like I said, our blood pressure does fluctuate throughout the day. So we want to have more of a normal state of being. And we did talk about some fluctuations in blood pressure, which is good. So exercise is good. We know at least 30 minutes a day is helpful for patients. Um, so it's not that you want to avoid any fluctuations in your blood pressure, but at a resting, calm, sleeping, normal functioning standpoint, we want that number to be pretty stably less than or around 120.

Host: Now tell us more about these new additions at Summa Health that specialize in this area.

Alexander Venizelos, MD: Yeah, we are super proud of ourselves over the past couple years we've attained a status called Comprehensive Stroke Certification and what that is, it's the highest level of stroke certification that you can obtain.

It's the highest in the region and between Cleveland and Columbus, we're the only institution that have acquired that Comprehensive Status. So in addition to being Comprehensive Stroke Certified, which just means we can teach, we can treat the most complex types of strokes, um, in a very efficient way; we've also achieved several awards throughout the years from health grades, which is distributed by the American Heart Association. So for the past six years, we've had five stars for treatment of stroke. For the past five years, we've received a Stroke Care Excellence Award. And then for four years in a row, we've been, uh, Summa has been a five star recipient of America's 100 Best Hospitals in Stroke Care and received Neuroscience Excellence Awards for the past four years as well.

And, you know, just kind of hot off the presses in 2023, we, uh, did receive the number one award uh, the number one hospital for neuroscience care in the state and the number two for stroke care in the state. So we are very proud of the work that we've done to achieve all of these honors, uh, given by the American Heart Association and Health Grades, um, and also to achieve our very comprehensive status with the Joint Commission.

So we've done a lot of work to get here. There's a lot of people involved that have helped us achieve these awards. Um, and I'm just kind of one of them out here trying to let people know what to watch out for.

Host: Now, how can somebody access these, the services from Summa Health?

Alexander Venizelos, MD: So they can use the internet. Uh, they can call into our office. Um, if you want to learn more about stroke care tips and treatment at Summa Health, there is a website. So everybody get your pens out. Um, the website is summahealth, S-U-M-M-A-H-E-A-L-T-H. org/ brain. Again, that's summahealth.org/brain, and you can learn all about, uh, stroke care, treatments that are available, tips and tricks, and we're happy to kind of, uh, talk to whomever and get them to the right place, to the right doctor to treat the right thing.

Host: Once again, we're talking to Dr. Alexander Venizelos. He is, of course, the Medical Director of the Neuroendovascular Surgery at Summa Health Neuroscience Institute here in Akron. We're talking about stroke, we're talking about different problems with the brain, the spine. Can you recap, for somebody tuning in late, what you actually do?

Alexander Venizelos, MD: Yeah, absolutely. We use wires and catheters and, uh, technology to do minimally invasive surgeries in the head and the neck to treat patients with stroke and other blood vessel disorders in the head, the neck, the brain, and the face.

Host: And of course, this is part of the, uh, the, I guess the modern science of treating strokes and, uh, and these other kinds of, uh, of, uh, problems that people have with their brain, their spine, their head. Um, again, it can be pretty, uh, scary when somebody starts to experience some of these things themselves.

Alexander Venizelos, MD: Absolutely. Um, you know, we have patients all the time that, that present, you know, we talked a little bit about the risk factors for stroke, weakness on one side of the body, difficulty speaking. Um, you know, one, one patient we had was actually playing racquetball. We talked about exercise and stroke and cardiovascular disease. So he was playing racquetball with some friends. They were, um, shooting around the racket and he suddenly developed weakness on one side of his body. He couldn't talk. He couldn't move. 10, 15, 20 years ago, these patients would be kind of sent to a floor.

They would, uh, there was not a whole lot we could offer them in terms of medications or other types of support. And, you know, unfortunately, this person would have been dependent on um, care from a nursing facility or some other person, they wouldn't be able to care for himself. And when he came to the hospital, um, we were able to identify the stroke, uh, because his friends were able to call 911.

With our techniques, the CT scans that I discussed, the CTAs, the CT perfusions, and then, uh, we were able to identify a stroke, a blockage of a very large blood vessel in the brain. We took him from the emergency room directly to what we call the neuro interventional suite, which is an area where I use my tools and tricks.

We were able to pull out that clot. And actually, as soon as we pulled out the clock, this man who, you know, 10, 15, 20 years ago, might not be able to talk or walk or even use the restroom on his own, kind of looked up at me and he said, you know, I feel a lot better. You think I can go finish my game of racquetball?

So, uh, what, what we can do, and he was serious, what we can do, what we can offer now for strokes, for bleeds of the brain, for aneurysms, AVMs, is tremendously different than what we could have offered, uh, just not very long ago at all. So, it's a really nice place to be. It's a nice option to offer our community, and we're proud for the achievements and the awards that we've received.

Host: Again, it's wonderful that the greater Akron region has access to this latest and best in stroke and aneurysm treatments. What's more, what else do we know about the stroke and aneurysm services at Summa Health?

Alexander Venizelos, MD: So yeah, it's, uh, that's, you mentioned one of the things I'm most proud of is, uh, you know, before you know, there was a lot of these advancements I mentioned in the past couple years.

Um, we had to take these patients out of their communities in the greater Akron area and send them to, um, you know, other cities, other regions, and to get the care that they needed. And so, what we've been able to do, and Summa has taken a very special interest in the community, is to be able to offer these types of therapies, um, in our own backyard. We can treat patients. It's easier for families to come visit. Um, families can stay close to home. They can rehabilitate closer to the home, which time and time again shows, um, you know, family involvement in medical care leads to better outcomes. So, it's been really nice to be part of a movement. Um, and, you know, I'm from the Northeast Ohio area. It's been nice to bring back these types of therapies to Northeast Ohio in regions that previously didn't have an option.

Host: Now, where is the actual center located here in Akron?

Alexander Venizelos, MD: So, we are located off the Perkins exit. Uh, there's a brand new front, uh, area by the, off of Market, by the emergency room. Um, and that is where the front face of the building is. So, that's where our office is located as well. Um, off of the Perkins exit, uh, off of 8th, um, in the, in Akron, Ohio.

Host: Now, do you also offer educational programs for the community to learn more about this, uh, on their own?

Alexander Venizelos, MD: We do, we do. If you go to, uh, we have a stroke support group, and then we have, um, very frequent community outreach events where we talk about, excuse me, strokes, stroke symptoms, stroke warning signs, stroke treatment, and you can find that information on our website.

Host: And again, that website would be summahealth.org/brain. That would be the correct website to go to, right?

Alexander Venizelos, MD: Absolutely.

Host: So again, a lot more about that on the web. And you can also, is there any kind of phone number they could call if they wanted to find out more at this point?

Alexander Venizelos, MD: Yeah, there is. Let me pull up our office phone number. And this is a phone number that people can use just to call the office and find out more about stroke care. The office number, I don't have it memorized off the top of my head, is 330-375-7055. Again, that's 330-375-7055. The, um information for our phone numbers, for stroke care, for any additional information can also be found on that website you mentioned, summahealth. org/brain.

Host: Again, thank you to Dr. Alexander Venizelos, who is talking to us today, who is the Medical Director for Neuroendovascular Surgery at the Summa Health Neuroscience Institute in Akron, one of the most advanced places for stroke and other, uh, type of, uh, head, brain, spine care here in the area of stroke and, uh, the other diseases that can occur to somebody, uh, whether they're old or young. It's another issue, too, that we talk about a lot of having to do with age, but younger people can suffer these disabilities, too, can't they?

Alexander Venizelos, MD: Absolutely. And especially with COVID, we've seen a lot of different patterns in young people. We've seen more strokes in young people. We've seen different types of clots and larger clots and different types of clotting disorders that occur in stroke patients.

So, you know, especially in this day and age, it's important to have these patients evaluated if there are any of those symptoms. And then the other thing is aneurysms. So if people have multiple family members with blood vessels that have ruptured or bled in their brain. Um, you know, if two immediate family members both have subarachnoid bleeds; we recommend that the rest of their immediate family be screened for aneurysms because that can run in families as well. So, um, you know, there's a lot of opportunities here to, uh, to benefit patients.

Host: Once again, Dr. Alexander Venizelos, who is the Medical Director for the Neuroendovascular Surgery at Summa Health Neuroscience Institute here in Akron.

You can find out more about what he does and how they can help you either prevent a stroke or work with somebody you have who may have suffered a stroke. Again, you got to know more and you want to know more so you're informed and know exactly what's available here in greater Akron for top notch care in the area of stroke and other problems that can, uh, come out from, uh, getting older or just, uh, just existing in America today.

So go to the website to find out more, summahealth.org/brain. Summahealth.org/brain and find out more about the services at the Summa Health Neuroscience Institute here in Akron. So, Doctor, thank you so much for talking with us, taking time out of your day to inform us about this excellent services we have right here in Greater Akron.

Alexander Venizelos, MD: Yeah, Bob, thank you so much. It's been a pleasure, and thanks for all your questions and interest. We'll chat soon.

Host: Again, you can call and find out more at the website summahealth.org/brain. Again, uh, just a service of Summa Health here in Akron. I'm Mr. Sunday, Bob Lewis.

Outtake: The talk of Akron, WNIR.