Advanced Stroke Care - Just in Time

When someone is having a stroke, time is of the essence. Strokes (medical emergencies where blood flow to the brain is interrupted) are a leading cause of long-term disability and death in the United States. To expand and improve stroke care in San Angelo and the Concho Valley, Shannon has added endovascular neurosurgery to its top-of-line treatment options.

Shannon is proud to welcome Amon Zakeri, MD, to the Brain and Spine Institute as the first dual-trained endovascular neurosurgeon at Shannon. As a dual-trained endovascular neurosurgeon, he can offer both open surgery through an incision, or endovascular surgery by using a catheter inside blood vessels in the body. Though endovascular procedures have been used to treat strokes and other neurological conditions for several years, this highly specialized technique is new for the Brain and Spine Institute.

“At Shannon, we’ve had to transfer patients to other medical centers for emergency stroke care,” Dr. Zakeri noted. “Now that we have these services in San Angelo, our patients can undergo surgery here with better outcomes for long-term recovery.”

Endovascular neurosurgery can help address a variety of neurological and cardiovascular diseases by using a small catheter system to enter the body through blood vessels in the wrist or groin. Once inside the blood vessels, the catheter system can be used to obtain high-definition radiologic images while simultaneously allowing for treatment of strokes, aneurysms, carotid stenosis and other neurological conditions. Depending on the severity of different conditions, endovascular procedures offer a minimally invasive way to address and treat diseases of the blood vessels.

“In stroke, we say that ‘time is brain’ – that means that the longer blood flow is interrupted to the brain, the greater risk there is of damage to brain tissue and permanent disability,” said Dr. Zakeri.

“Endovascular neurosurgery gives us access to very delicate areas of the brain. Directly targeting the blood vessels themselves means we can restore blood flow to the brain faster in the event of a stroke.”

Endovascular thrombectomy is a new, cutting-edge treatment for both ischemic stroke. An ischemic stroke occurs when plaque or a clot blocks a blood vessel in the brain, preventing the brain cells from receiving vital oxygen and nutrients. Hemorrhagic strokes occur when a blood vessel in the brain leaks or bursts, disrupting circulation and placing extra pressure on the brain tissue. According to Dr. Zakeri, endovascular thrombectomy can provide better chances of recovery for patients needing immediate treatment.

“In conjunction with thrombolytic (clot-busting) medication, we can now use endovascular thrombectomy to locate a clot within a blood vessel and

locate a clot within a blood vessel and remove that clot. When the catheter reaches the clogged artery, we can place a stent to capture the clot or aspirate [suck] it out of the blood vessel, helping restore blood flow to the brain. For patients dealing with something as debilitating as a stroke, that kind of pinpoint treatment can help salvage their ability to walk and talk and function in everyday life.”

Endovascular techniques can be used to treat other conditions that lead to strokes and bleeding in the brain. During a middle meningeal artery embolization, the surgeon uses the endovascular catheter system to permanently block an artery on the outside of the brain with a liquid sealant. This is done to staunch a slow bleed on the outside of the brain (known as a chronic subdural hematoma). Endovascular neurosurgery surgery can allow the surgeon to close off a brain aneurysm (a bulging spot in a blood vessel) using a clamp or coil to prevent it from rupturing and causing a hemorrhagic stroke.

State-of-the-art equipment in the endovascular neurosurgery suite also brings new diagnostic opportunities to Shannon. Offering tests like diagnostic cerebral angiograms further gives patients in the region options for specialized neurovascular care closer to home.

“Diagnostic cerebral angiograms are the gold standard of medical imaging in diagnosing cerebral vascular disease. By offering them at Shannon, we have the chance to diagnose a lot of problems in the brain sooner. During an angiogram, we can identify conditions with fluoroscopic imaging, many of which have much better treatment outcomes if we intervene earlier,” explained Dr. Zakeri.

Adding endovascular neurosurgical procedures to Shannon’s existing treatments for stroke patients is an endeavor toward more accessible, high-quality healthcare in the Concho Valley. For Dr. Zakeri, focusing on meeting the needs of each individual patient is part of providing critical stroke care at the community level.

“Shannon is in a unique position to provide this kind of care, because our service area covers so much of the state of Texas,” Dr. Zakeri said. “The people in our communities are so hard-working and so dedicated to their families; I’m thankful we can provide these interventions here and give people peace, knowing they’re cared for in the same way we’d want for our own families during an emergency. By bringing in new technology like endovascular neurosurgery we’re improving stroke care for our patients, our neighbors, and reducing the emotional and logistical stress for their caregivers too.”