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Monday, June 23, 2008

UNMH Takes Part in Trial of Bypass Surgery That Helps Oxygen Get to the Brain, Allowing Some to Recover Better From Mild Strokes

By Olivier Uyttebrouck
Copyright © 2008 Albuquerque Journal; Journal Staff Writer
    Two mild strokes left Martin Smiedt running at half speed, struggling to think and to speak.
    "The thought is in your head, but you can't turn the thought into action," said Smiedt, 65, who suffered a stroke in 2006 and a second in February.
    Smiedt's underlying problem: a lifetime's accumulation of plaque and cholesterol that had sealed off his carotid artery, the main conduit of blood to the head. The blockage left Smiedt's brain starved for oxygen and nutrients.
    "I couldn't think," he said. "What came out of my mouth nobody could understand."
    Smiedt believes he got a break this year.
    University of New Mexico neurosurgeon Dr. Howard Yonas tapped Smiedt for a clinical study that uses arterial bypass surgery to increase the flow of blood to the brain.
    UNM is one of 22 medical centers nationally participating in the trial, called the Carotid Occlusion Surgical Study, or COSS, funded by the National Institutes of Health. An occlusion refers to an artery that is completely closed and transports no blood.
    Smiedt underwent the bypass surgery in April. He said the benefit from the procedure was "huge."
    The Farmington car salesman said in a recent telephone interview that he has fully regained his ability to think and speak clearly.
    "There's no way to even explain it," he said. "I'm almost better than I was before I had the first stroke."
    Yonas said bypass surgery holds promise for people who have suffered a moderate stroke and have a carotid occlusion, leaving their brains "hungry" for sustenance.
    "They're living in a twilight zone," Yonas said of such patients. "They don't have a major stroke, but they're at elevated risk for stroke and they don't get enough blood flow."
   
Stroke symptoms
    Consequences can be terrible for people with blood-starved brains. Symptoms include poor vision and speech, muddled thinking and paralysis.
    Because their brains are just barely getting enough oxygen, the risk of having a major stroke are fivefold or greater for these patients, Yonas said. Even a slight decrease in the blood-oxygen level can initiate a stroke. By increasing the supply of blood, the bypass can significantly reduce the risk of a future stroke, he said.
    The surgeon reroutes the temporal artery, the source of the pulse in the temple, through a small opening in the skull just over the ear and splices it to an artery on the surface of the brain.
    Yonas uses microscopic surgical tools to join arteries each less than 2 millimeters in diameter. Peering through a microscope with a 60-fold magnification power, Yonas uses needles the width of a hair to suture the arteries together.
    Smiedt was the second New Mexico man to receive the bypass.
    The first, Victor Deanda, 73, said he has made steady progress since his surgery in April 2007, four months after a stroke left him with impaired speech, vision and temporary paralysis.
    Deanda has since recovered most of his motor skills, though his speech remains halting. His cognitive skills are about the same today as before his stroke, he said.
    "Everything's the same in my brain," Deanda said Wednesday. "I can think, I can see, I can read. I know exactly what you're talking about."
    How much of Deanda's progress is attributable to the surgery is hard to gauge because he had been improving before the bypass, said his wife, Lori Deanda.
    One apparent effect of the surgery was restoration of sight in Deanda's left eye, which had been damaged by low blood flow, she said. But the couple believe the chief benefit of the surgery is protection from a future stroke.
    "Our goal wasn't so much to make him better," she said. "It was to decrease his risk of having another (stroke)."
   
Older concept
    Carotid artery bypass surgery is not new, but it has not always appeared promising.
    The technique dates to the late 1960s, according to the study's Web site. A major study completed in 1985 found "no benefit" to patients who received the bypass, it said.
    "We did this trial and we really couldn't say we did any good," said Yonas, who participated in the study. "It was quite painful."
    But physicians at that time lacked the imaging tools required to identify patients who could truly benefit from the surgery, he said.
    The technique is effective only in patients who have had mild to moderate strokes and who suffer a lack of oxygen to the brain as a consequence of a fully blocked carotid artery, Yonas said.
    Surprisingly, he said, most people can function perfectly well with a blocked carotid artery because the human circulatory system has alternative routes for getting blood to the brain.
    In fact, up to 80 percent of humans could survive a carotid occlusion and would derive little or no benefit from bypass surgery, Yonas said.
    "You can close that (carotid) artery and do OK. That's why the species made it this long."
    About Strokes
    WHAT IS A STROKE?
    A sudden attack that cuts off the flow of blood and oxygen to the brain.
    TYPES OF STROKE
   

Ischemic stroke occurs when an artery is blocked by a buildup of plaque, fatty deposits or a blood clot.
   

Hemmoragic stroke occurs when a blood vessel breaks, leaking blood into the brain.
    Stroke Symptoms
    The American Heart Association has devised a quick checklist intended to detect stroke symptoms and get the victim prompt attention.
    FAST is an acronym for face, arms, speech and time. Ask the person three questions and observe the response.
   

Face: Ask the person to smile. Look for a drooping smile on one side.
   

Arms: Ask the person to close their eyes and raise both arms. Watch for one arm drifting downward.
   

Speech: Ask the person to repeat a simple sentence. Does the speech sound slurred or strange?
   

Time: If you observe any of these signs, call 911.