S
T R O K E
T
R E A T M E N T
ENDOVASCULAR SURGERY
HEALING FROM
THE INSIDE OUT
A RECOVERY THAT’S
as speedy and pain-free as
possible—this is a key goal of endovascular surgery, a
treatment for o en serious blood vessel problems.
Endovascular
means “inside blood vessels.” And that’s
exactly where doctors perform this minimally invasive
surgery. Guided by x-ray images on a video screen, they
thread tiny instruments into diseased or damaged vessels
to x them—all in the angiographic suite, instead of the
main operating room.
Chances are you’re already familiar with the very rst
endovascular procedure—angioplasty, pioneered in the
s. In this procedure, doctors help restore blood ow
in dangerously clogged arteries in the heart, lower legs
and other parts of the body by inserting a slender tube
into the artery and then in ating a balloon at its tip.
REPAIRING DANGEROUS WEAK SPOTS
“
Today, endovascular surgery is also
used to treat a variety of cerebrovascular
diseases—disorders of the blood vessels
of the head and neck—including stroke,
aneurysms and tumors,” says Armen
Choulakian, MD, a neurosurgeon at
Glendale Adventist Medical Center
(
GAMC) who performs both endovas-
cular and open surgical treatments for
intracranial aneurysms. Aneurysms are
weak spots in blood vessels that bulge and could burst
and cause deadly bleeding. O en the surgery treats aneu-
rysms that form in the aorta, the body’s largest artery.
Dr. Choulakian completed his general surgery intern-
ship and neurosurgical residency at the University of Texas
Southwestern Medical Center in Dallas with an interest
in cerebrovascular microsurgery. He also completed a
subspecialty fellowship in endovascular neurosurgery at
Cedars-Sinai Medical Center. Dr. Choulakian has pub-
lished in multiple peer-reviewed journals and presented
at numerous scienti c meetings. He brings a depth of
knowledge to GAMC, including services from acute
stroke intervention to cerebrovascular microsurgery. He
collaborates with patients, caregivers and local physicians
for the best care possible for his patients.
WHAT HAPPENS IN SURGERY?
ere are two common
treatment options for a brain aneurysm.
e rst option is surgical clipping. is is a procedure
to close o an aneurysm. e neurosurgeon removes a
section of the skull to access the aneurysm and locates the
blood vessel that feeds the aneurysm. e neurosurgeon
then places a tiny metal clip on the neck of the aneurysm
to stop the blood ow to it.
e second option is through an endovascular coiling.
is is a less invasive procedure than surgical clipping. e
neurosurgeon inserts a hollow plastic tube (catheter) into
an artery, usually in the groin, and threads it through the
body to the aneurysm. e neurosurgeon then uses a guide
wire to push a so platinumwire through the catheter and
into the aneurysm. e wire coils up inside the aneurysm,
disrupts the blood ow and causes the blood to clot. is
clotting essentially seals o the aneurysm from the artery.
A common cause and treatment of stroke
1
Plaque builds up in an
artery in the brain.
2
The plaque breaks up
and a blood clot forms,
blocking blood flow and
causing a stroke.
3
A drug breaks up the
clot, which restores blood
flow.
Coffey infographic with information
from the American Heart Association
e neurosurgeon will be able to make a recommenda-
tion based on the size of the brain aneurysm, the patient’s
ability to undergo surgery and other factors.
THE BENEFITS
“
Compared with conventional aneurysm
surgery, endovascular repair has important advantages,”
Dr. Choulakian says. “Generally,
patients have shorter hospital
stays, less pain and fewer com-
plications. Endovascular surgery
may also be a safer option for
anyone with a health problem
that heightens the risks of major
surgery.”
In addition, endovascular
surgery can be used to treat arte-
riovenous malformation (AVM),
a tangle of abnormal blood ves-
sels that occur in the brain. Le
untreated, AVMs can cause the
blood vessels to rupture and cause
bleeding in the brain. However,
once diagnosed, a brain AVM can
o en be treated successfully.
MORE ABOUT GAMC
GAMC has
earned the Get With e Guide-
lines® honor roll recognition from
the American Heart Association/
American Stroke Association for
Target: Stroke.
e goal of participating in Get
With e Guidelines is to save
lives. Hospitals, like GAMC, that
implement Get With e Guide-
lines realize measurable results,
including improved patient
outcomes and fewer recurring
events. It’s a di erence that shows
in the lives of patients and their
families and in the satisfaction
felt by caregivers empowered to
do their best.
GAMC’s greatest reward is caring for our patients.
at’s why we’re committed to turning treatment guide-
lines into lifelines.
For more information about the Neuroscience
Institute at GAMC, call
( )
-
or visit
GlendaleAdventist.com/neuro
.
Armen
Choulakian, MD,
neurosurgeon
at GAMC
1
2
3
The American Heart Association
and American Stroke Association
recognize this hospital for achieving
85%
or higher adherence to all
Get With The Guidelines®Stroke
Performance Achievement indicators
for consecutive 12-month intervals
and 75% or higher compliance with
6
of 10 Get With The Guidelines
Stroke Quality Measures to improve
quality of patient care and outcomes
in addition to achieving IV rt-PA door-
to-needle times ≤ 60 minutes in 50%
or more of applicable acute ischemic
stroke patients (minimum of 6)
during one calendar quarter.
4
( 8 5 5 ) 3 6 0 -
G A M C
H Q
•
W I N T E R 2 0 1 3