Innovative surgery prevents stroke

NAGPUR: Timely diagnosis and a special surgical intervention by doctors at the Orange City Hospital and Research Institute (OCHRI) averted a dangerous situation like stroke in a 65-year-old man hailing from a village near the city. The hospital claims that such a procedure was done for the first time in the city.
The patient came to the hospital with typical symptoms of slurred speech and loss of vision in the right eye, which if picked in time can prevent brain stroke and save a person's life."The patient had typical indications of the danger ahead and luckily for him the doppler picked up the 70% block in the carotid artery, the artery in neck which supplies the brain. Had it been not cleared in time, the block could have led to a brain stroke," said Dr Anup Marar, medical director of OCHRI.
Dr Rohit Gupta, a vascular surgeon who performed the surgery, told TOI that there are various methods of clearing the block in carotid artery. "One of the common methods is angioplasty or putting a stent in the blocked area. But there are many disadvantages of this procedure, including the cost. In the era of carotid artery stenting, still carotid endarterectomy (a method of cleaning the block surgically) or CE remains the gold standard. So, we decided to use this technique against angioplasty," said Dr Gupta.
The blockage in the carotid artery was actually leading to discharge of some of the deposited cholesterol moving randomly once in while upwards into the brain. Depending on the area of brain where these pieces were moving, the patient was responding accordingly. Hence the person's speech and vision were affected.
After the surgery on February 11, the patient responded very well and regained his speech and vision. Otherwise also, the slurring of speech and loss of vision in such case is a temporary phenomenon lasting for a day or so. But if the patient is aware and sees the doctor in time he/she can be treated and a brain stroke can be averted. Whether this patient was aware of the symptoms is not clear but he did approach the doctors in time and hence was saved of the stroke.
"In this patient, we went one step ahead of the conventional carotid endarterectomy and used a procedure called as modified eversion carotid endarterectomy or MECE on the right carotid artery. This method expeditiously removes the block or plaque through a linear incision," said Dr Gupta.
The other members in the team that performed the surgery included Dr Smita Harkare, Dr Neeta Deshpande, Dr Anita Pande, Dr Swapna Bhure as anaesthetist. Dr Kavita Dhurvey and Sister Sandhya Dhanwatey worked as paramedical staff.
Work of precision
*In angioplasty, crossing the lesion of block is risky and can cause embolism and recurrence of blockage. Also patient has to be put on dual anti-blood clotting medicines
*But in carotid endarterectomy (a method of cleaning the block surgically) or modified eversion carotid endarterectomy (MECE), recurrence rate is very low
*In CE, the two ends of the blocked artery are first clamped
*Then the surgeon opens up the area of the blocked vessel
*The plague is scooped out
*The blood vessel is closed by suturing it