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>> Tonight.
>> I was fairly active person physically.
>> I was feeling fine. No signs at all that this is going to happen.
>> An ABC27 special presentation.
>> Until you have a neurological event most people have no idea that they have carotid
artery disease.
>> Penn State Hershey Neuroscience Institute presents Brain Power: Carotid Artery Disease
brought to you by Penn State Milton S. Hershey Medical Center.
>> Good evening, I'm Chuck Rhodes. Stroke is a third leading cause of death in the United
States. Every year, about 795,000 people in the United States have a stroke. Carotid artery
disease is often the cause. The New England Journal of Medicine concluded that the ultrasound
scanning of carotid arteries is the single best predictor of stroke and heart disease.
>> A Lancaster County man was in tip top shape when suddenly he keeled over at the bank.
He didn't know what was happening until doctors told him he had a stroke.
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>> Exercise is a big part of Frank Byrne's life and his wife Ann keeps right up with
him. If they're not walking their greyhounds, they're biking or running and that's how they
met.
>> We will both runners and I met her in Central Park and through some friends and that's where
it started.
>> Over the years, Frank competed in 8 marathon including New York City with the time of 2
hours 50 minutes. He's placed a numerous 5k runs.
>> Frank is the paragon of fitness.
>> So fit, so healthy, Frank thought so too until 3 years ago when he was in New York
City.
>> I went out for jogging, I ran about 4 miles and everything was fine. I had no symptoms
or anything. But then it just hit me. My left hand was so numb, something dropped out--I
had some papers that dropped out onto the ground. I want to retrieve them and I keeled
over and that's when they called the ambulance and I was taken to the hospital.
>> I was here a home in Lancaster and I got a call from the emergency room in Elmhurst
Hospital and the doctor said that Frank had had a stroke. I was shocked. Frank is a healthy
fit person. I had--I know he had hypertension but it was well controlled and I just--it
was just hard to believe that this is gonna happen to Frank.
>> They run a whole series of test and they were pretty convinced I had blockage in the
carotid artery and that's of course the stroke. A clot broke off and then it went to my brain.
>> Frank contacted Dr. Robert Harbaugh at Penn State Hershey Neuroscience Institute.
>> This is a case of severe right carotid artery stenosis as was the case for Mr. Byrne.
And what it demonstrates is the common carotid artery dividing into an external carotid going
to the face and scalp and an internal carotid going to the brain. Right here at the origin
it's very, very narrow. You can hardly see any contrast going across.
>> 80 to 90 percent of the carotid artery was blocked.
>> He is a very high risk for another potentially disabling stroke because of the fact that
he was symptomatic and had a high degree of stenosis narrowing at the vessel. And I told
him I thought it was essential to go ahead and get that carotid artery fixed.
>> Dr. Harbaugh knew the best surgical solution.
>> It's a carotid endarterectomy and it's actually opening up the artery and cleaning
out the plaque that's built up over many years, washing the artery out thoroughly and then
closing it back up.
>> I wasn't disturbed by the prospect of the surgery. I was happy 'cause then I would avoid
the same thing again and that's why I wanted to get it done.
>> It would reduce the chances of him having a repeat stroke. So that to me was a lifeline.
>> He's sort of the ideal patient to operate on but one that I don't see too often in a
very thin and good shape and it is actually a really straightforward operation.
>> Dr. Harbaugh came down and told me that, you know, things went well. And of course
Frank didn't have general anesthesia so he was awake and I could go the recovery room
and see him.
>> Frank spent one night in the hospital. A week later, he was active again.
>> He is able to run and he, you know, he's active and I think that he's done really well.
>> I still can do things. Go to gym to do weights and whatever, run and swim and things
like that without any real effect.
>> And Frank told me after the surgery, three months after the surgery, he and his wife
Ann on a biking vacation in Greece. There they bike 50 to 60 miles a day. Frank says
that from the stroke he does have some numbness in his fingers and his left side is weaker
but it's not stopping from doing the things he loves. Back to you Chuck.
>> He didn't look like it at all, that's amazing. Well, joining us now is Robert Harbaugh in
the studio and doctor let's begin with the basic question. What is carotid artery disease?
>> Well, the carotid arteries are major arteries in the neck carrying blood to the brain and
it's possible to develop build up of plaque that narrows the arteries. And if that becomes
severe enough, it can lead to clots forming, breaking off, going downstream and causing
a stroke.
>> Okay. Well, let's begin with that then. What happens to a person when they have a
stroke?
>> Well, there are two kinds of stroke. Hemorrhagic strokes are bleeding in the brain that's less
known and the kind of stroke we'll be talking about tonight is an ischemic stroke, lost
of blood flow to a part of the brain. And if a portion of the brain losses its blood
flow, that portion of the brain stops working. So if it's the part of the brain that allows
you to speak, you can no longer speak. If it's the part that allows you to use your
right hand, you can't use your right hand. And if you have a complete loss of blood flow
for a short period of time that's 5 minutes to any part of the brain at normal body temperature,
that part of the brain dies.
>> Okay. Now, how do we--how do you diagnose this disease and I have a question, is it
different for male or female when you diagnose this?
>> Right. Well, very often people don't know they have carotid artery disease and the diagnosis
isn't made until a stroke or a TIA warning symptoms of stroke occurs. In some other patient
patients if they have risk profile, they have risk factors that we know leads to narrowing
of the arteries, they can be evaluated before a stroke occurs with various types of imaging
modalities to see if they do have a narrow carotid artery.
>> Now, some of diagnosis is it ever save to let this go untreated?
>> I think to find carotid artery disease and not treat it at all is a mistake. And
most of these patients can be treated especially if they're asymptomatic. They can be treated
with medical management without any invasive procedures.
>> Let's talk about some of those treatments. What will we be facing as a patient?
>> Right. Well, if someone is found to have carotid artery disease, I think the most important
thing is to manage the risk. If the person is a smoker to stop smoking, if he or she
has diabetes, to manage the diabetes, control blood pressure, make sure that the cholesterol
levels are appropriate and all of those sorts of management things are medical in nature.
In some patients, in addition to the medical management we may wanna treat the carotid
artery disease either with endovascular treatment or surgery.
>> We'll talk about some more of those treatment options--
>> Now, joining us here in the call center to help answer the viewer questions is Dr.
Kevin Cockroft, thanks for joining us tonight.
>> Thank you.
>> Here is the first viewer question. My grandmother has hardening of the arteries. Is this hereditary?
>> Yes, it is, it can be. Many patients will have a family history of carotid disease.
If it turns out that your family members had this problem when they're very young, then
that's a risk factor for you also having that problem.
>> And they should talk to their doctor?
>> Yes. It turns out there are many test that we can do. As simple as a physical examination
in the doctors office maybe tell if you have that disease or even some simple test which
are noninvasive and no risk to you.
>> Okay and here is the second question.
>> I'm 41 years old, exercise regularly and eat healthy. Why do I have problems with high
cholesterol?
>> Well, that's kind of related to the previous question. This person may actually have a
problem with the family history. So they have a genetic predisposition to having this carotid
artery disease. Now, that doesn't mean that the other things that they do, the diet, exercise
and all that are no so important. They are still very important and those things are
actually more common causes of carotid artery disease than their hereditary part.
>> Okay, thanks so much and we will check back with you in a few more minutes with more
viewer questions. We will send it back to you in studio, Chuck?
>> Thank you Debra and again I'm with Dr. Harbaugh and lets talk about one of the basic
ingredients in this problem that seems to be cholesterol. A lot of lay people think
they know something about it that's probably dangerous in itself. Tell me the different
between what we call good cholesterol bad cholesterol. And is high cholesterol is that
a risk for this disease?
>> Well, the cholesterol profile that a patient has total cholesterol, the ratio between the
high-density lipoprotein or good cholesterol and the low-density lipoprotein or bad cholesterol
is also important. So part of the medical management of carotid artery disease will
be to try to normalize the cholesterol and make that ratio better to reduce the risk
of stroke.
>> What are some of the other risk factors? There has to be a laundry list of these things.
>> Alright. Well, there is smoking which is a huge factor. There is hypertension, high
blood pressure, diabetes is a factor and then there are risk factors that you can't do anything
about like age and family history. And people who have the whole range of risk factors high
blood pressure, diabetes, high cholesterol, smoke, positive family history may well develop
carotid artery disease in their 30s or 40s. If you have no risk factors, it doesn't mean
you won't develop carotid artery disease but it's usually much later in life.
>> Okay. Well, thank you doctor and--