More Than One Way to Treat a Stroke

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Hello, and welcome to our show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Satoshi Tateshima, interventional neuroradiologist, MemorialCare Neuroscience Institute, Long Beach Memorial, and associate professor, Interventional Neuroradiology, University of California, Los Angeles. Welcome, Dr. Tateshima.

Satoshi Tateshima, MD: Thank you. Thank you very much for having me here.

Deborah Howell (Host): It's all our pleasure. What does an interventional neuroradiologist specialize in?

Satoshi Tateshima, MD: It essentially specializes in any brain diseases. It is a catheter-based, very low invasive procedure, but because of its low invasive nature, it is very good to treat all kind of stroke patients, like subarachnoid hemorrhage or any acute ischemic strokes.

Deborah Howell (Host): Okay. All right. And why is an interventional neuroradiologist a critical part of the stroke team in hospitals?

Satoshi Tateshima, MD: Because the speed is the keyword here. In general, a patient suffering from an acute ischemic stroke as a result of a blockage of a large brain artery, approximately 1.9 million neurons, nerve cells, die every minute. And also more than eight miles, close to eight miles of brain fibers are lost, which means that every minute they lose brain function. So we cannot really wait. We have to get to the lesion and we have to open that blockage to restore the flow to the downstream. And for that, this low invasive and very quick access to the brain plays a significant role.

Deborah Howell (Host): Okay. As they say, time is brain, is that correct?

Satoshi Tateshima, MD: Yes, that's correct.

Deborah Howell (Host): So for many years, surgery was the only treatment available for many conditions such as stroke. Today, interventional radiology treatments provide another less invasive option for treating stroke and also aneurysms. So, can you explain the additional options for treatment?

Satoshi Tateshima, MD: Additional options. Before interventional procedure became available to us, essentially two options. One is medical management. We just do nothing, or just try to manage, let's say a patient with brain aneurysm, try to reduce risk factors like cigarette smoking or maintain blood pressure, things like that. That's one option. And another option was surgery. Open the skull, dissect the brain and get to the lesion. And if there is aneurysm, we clip it. And if there is a blockage, surgically remove or put a bypass, some bypass surgery. There were two options. And they still are very important options. We have to provide those options to the patients. And in the late nineties, interventional procedure became available to us and to the patients, and now that's also very valuable options because a patient suffering from additional diseases like a lot of comorbidities, they may not be a good candidate for open surgery, and some condition is severe enough not to be treated by medical management. And then interventional procedure may be the only option for them.

Deborah Howell (Host): Okay. Now, how are these techniques less invasive than traditional surgery methods?

Satoshi Tateshima, MD: It is a catheter-based procedure, so we don't have to get to the brain. We don't have to dissect the brain. We don't have to remove or dissect. Essentially brain environment is preserved. We get to the brain via arteries or veins, so we don't leave any scar in the brain. That's what makes this very less invasive.

Deborah Howell (Host): Absolutely. Of course. And who would be an ideal candidate for interventional treatment?

Satoshi Tateshima, MD: Essentially everybody. If there is a right indication, anatomy permits, we can virtually treat everybody. But this low invasive procedure is particularly ideal for a patient with a lot of comorbidities or who cannot be a good surgical candidate, such as older patients. Interventional procedure may be the only available options for them.

Deborah Howell (Host): I see. Okay. Now if a person has a brain aneurysm and they're a candidate for interventional treatment, how would the division of interventional neuroradiology team treat it?

Satoshi Tateshima, MD: There are many ways to treat it, and depending on the size of the aneurysm and location and its presentation, we select the best treatment. But we primarily use soft platinum coils to pack the brain aneurysm so that it is isolated from the systemic circulation and the aneurysm is thus protected. And sometimes the disease or aneurysm is too large or damage is not just a small area, it may be very extensive and the artery cannot be repaired. In that case we have to use a stent, that's a metal mesh, and we can reconstruct the whole brain arteries including aneurysm. So depending on the condition, we can provide variety of treatment options to our patients.

Deborah Howell (Host): Sure. I hadn't realized that stents are still made of, what did you say exactly?

Satoshi Tateshima, MD: Metal. Like a nitinol. Some stents are made of nitinol. That's a shape memory alloy. And some stents are made out of cobalt chromium.

Deborah Howell (Host): Really? I for some reason I thought we'd gone to the plastic side, but...

Satoshi Tateshima, MD: Yes, polymer stents that's available, but in the brain, the problem of a polymer stent is that, particularly some like bioabsorbable stents that's now available in the other part of the body, but the problem is any small fragments that may be created from those polymer or biodegradable, absorbable stents, that may fly downstream and that may cause a stroke in the brain. And the brain carries very significant roles. Each part of the brain carries very significant roles, so we don't want to have any downstream debris coming out of a stent. So we still use old metal. And that's the safest so far.

Deborah Howell (Host): That's very interesting to me. What else should we know about your profession and your specific duties that you have as a neuroradiologist?

Satoshi Tateshima, MD: Neuroradiology, this is actually a very overlapping field. So although we call this interventional neuroradiology, people sometimes call this endovascular neurosurgery, or interventional neurology, or interventional surgical neuroradiology. People call this specialty many ways because we can cover very wide range of diseases. And sometimes it may not be right for us, but still we are more than happy to see those patients because we can refer those patients to appropriate services such as open neurosurgery, or radiosurgery, or neurology, or neurorehabilitation, things like that. So virtually we see all patients.

Deborah Howell (Host): Okay. It sounds like you're a man who really loves what you do.

Satoshi Tateshima, MD: Yes, this is... unfortunately, of course, I have to see sad cases, a patient suffering from stroke, I feel really bad, but we really enjoy saving our patients. And also what we enjoy here is, we unfortunately cannot really treat all patients, we cannot really save all of them, but we learn a lot and we are trying to advance our field and improve our device and treatment methodology. That's a research. And we are committed not just to do clinical cases but also research to improve the patient care.

Deborah Howell (Host): And you learn with every case, right?

Satoshi Tateshima, MD: Yes, and we... I'm still learning. I've been doing this for like 10 years, but yes, every day I'm still learning.

Deborah Howell (Host): From the first day you started doing these procedures to today, say 10 years, how much, what's the scope of the change for a patient?

Satoshi Tateshima, MD: The scope of the change, I'm sorry, meaning?

Deborah Howell (Host): Meaning how is it different? How are the outcomes different? How is the treatment hard on the body 10 years ago compared to now? It's got to be much easier.

Satoshi Tateshima, MD: Yes, that's a great question. Maybe 10 years ago, many devices were still difficult to use for certain neurointerventionalists, but now devices are much better, so that made our procedure safer and also less actually operator dependent. Less operator skill dependent. So, certain very difficult conditions, very experienced operator can provide better outcome to the patients, that's the fact. But let's say acute stroke, we cannot have very experienced operator always available 24/7. So if a device enables even relatively inexperienced operator to achieve a very good success rate and outcome, that's ideal. And that's what's happening now. All devices are very easy to use and very efficacious and provide us very good results.

Deborah Howell (Host): And that is very good news indeed. I do have one final question. If someone is interested in getting more information on the stroke program and the Division of Interventional Neuroradiology at Long Beach Memorial, who can they call?

Satoshi Tateshima, MD: The number is 562-933-4006. That's Angie West. She's our stroke director. And if needed, she can direct the line to neurosurgery, or interventional neuroradiology, or neurology to the appropriate contact person.

Deborah Howell (Host): Beautiful. Thank you so, so much Dr. Tateshima for all your good information today. It's been a pleasure having you on the program today.

Satoshi Tateshima, MD: Thanks so much.

Deborah Howell (Host): And if you'd like to listen to the podcast or for more info, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Get out there and have a fantastic day.