In defense of our patients | Journal of NeuroInterventional Surgery

There is a great editorial in JNIS about stoke care at Comprehensive Stroke Centers and ongoing debate about how we as a medical community should address the inefficiencies in stroke care.  Worth reading for anybody interested in stroke and stroke intervention.  Click below to go to the article.

Source: In defense of our patients | Journal of NeuroInterventional Surgery

Carotid Disease – Stroke Awareness Month – May 2017

Moderate Carotid Artery Stenosis.

Carotid Artery Stenosis is a common cause of stroke.  In fact, roughly 7 to 18% of all first time stroke is attributed to carotid artery stenosis in excess of 60%.  That means that roughly 1 in 10 strokes is due to narrowing of the carotid artery.

There is debate regarding the best treatment for carotid artery stenosis. I won’t get into the relative risks and benefits of each in this post, but in general the treatment options for carotid stenosis include:

  1. Medical Treatment – aggressive medical treatment usually involves aspirin, clopidogrel, a statin, as well as aggressive blood pressure and diabetes control.  This may be the best option for asymptomatic carotid stenosis.
  2. Carotid Endarterectomy (Surgery) – this is a surgical procedure in which an incision is made on the neck and the carotid artery is exposed.  The artery is then temporarily occluded with clamps.  The artery is then opened with a scalpel, the plaque is removed, and then the artery is repaired.  This has been a common treatment for many decades, and is well studied with very good results.
  3. Carotid Angioplasty and Stent (Endovascular Treatment) – this is an endovascular procedure to treat carotid disease.  This is done awake in the
    Pre-Treatment, severe >90% left internal carotid artery stenosis. The arrow denotes severe stenosis, or narrowing. This is seen as a tiny string of contrast at the arrow. The external carotid artery, which supplies blood to the face and scalp, fills much more rapidly than the internal carotid artery, which supplies the brain.

    cath lab.  A guide sheath is placed into an artery in the leg, it is navigated to the common carotid artery in the neck, and then the carotid narrowing is treated from within the blood vessel.  The narrowed carotid artery is ballooned opened with a balloon catheter and a stent is placed to help keep the artery open.  In the images to the right and below, there is a representative example of the treatment of left internal carotid stenosis with angioplasty and stent placement.  In the image to the right, the narrowing is a tiny string of contrast at the arrow, which is causing severe limitation in flow into the left internal carotid artery.  Below, you can see the post angioplasty and stent results, after the narrowing has been “ballooned open” and a stent placed.

Post carotid angioplasty and stent placement.
Post treatment, unsubtracted and magnified to see stent inside left internal carotid artery.








Dr. Lawson treats carotid disease with all of the methods noted above; medical, surgical, and endovascular.  All of his carotid procedures are tracked in a registry (the National Neurosurgery Quality and Outcomes Database, also known as QOD – Neurovascular module) to ensure quality and safety.  Learn more about public quality data reporting at the Neuropoint Alliance.

Want to learn more?  Download the American Stroke Association guidelines for the management of carotid disease here.

Click here to contact the office for an appointment.

Baptist Health Care Stroke Symposium – May 19

I’m pleased to be one of the invited speakers to the Baptist Health Care Stroke Symposium in Pensacola, set for May 19, 2017.  I’ll be speaking about Hemorrhagic Stroke as well as the role of the TMH Comprehensive Stroke Center in our community.

This conference is geared for all health care providers, including physicians, ARNPs/PAs, nurses, therapists, and EMTs/paramedics.  CEUs are provided.

What’s special about the TMH Comprehensive Stroke Center?

Why is it important that TMH is a Comprehensive Stroke Center?

Comprehensive Stroke Centers (CSCs) are the most advanced hospitals for providing stroke care. Not only have they demonstrated excellence at caring for ischemic stroke and administering TPA, Comprehensive Stroke Centers have gone the extra mile to specialize in stroke diagnosis and treatment, including treatment for all forms of stroke. The only facility in Northwest Florida, South Georgia, and Southeast Alabama with Comprehensive Stroke Center services is Tallahassee Memorial Hospital (TMH).

Primary Stroke Centers (PSCs) can be thought of as the minimum requirement for stroke care. PSCs are able to diagnose and treat ischemic stroke. Most PSCs in the region rely on teleneurology, or neurologists available by computer or telephone, to help diagnose and treat patients. Comprehensive Stroke Centers, on the other hand, have in house neurology and neurosurgery services. TMH has 4 employed hospital stroke neurologists as well as 4 board-certified neurosurgeons at Tallahassee Neurological Clinic.

Drs. Lawson and Oliver. Board-certified neurosurgeons with neuroendovascular certification (CAST certification) at the TMH Comprehensive Stroke Center.

Comprehensive Stroke Centers not only provide excellent care for ischemic stroke, but they also provide advanced stroke care services. This includes care for ruptured cerebral aneurysms, AVMs, and other forms of hemorrhagic stroke. CSCs perform cutting edge procedures, such as thrombectomy for ischemic stroke due to large vessel occlusion as well as brain aneurysm treatment. They generally qualify as high volume treatment centers for aneurysmal subarachnoid hemorrhage, which means they generally have better outcomes than other centers that treat brain aneurysms.

Dr. Lawson was one of the first 50 individuals certified in Neuroendovascular Surgery by the Society of Neurological Surgeons.

Endovascular Neurosurgery (also known as Neuroendovascular Surgery or Neurointerventional Surgery) is a cornerstone in the Comprehensive Stroke Center model of care. At TMH we have two board-certified neurosurgeons, Drs. Lawson and Oliver, who are also certified in Neuroendovascular Surgery by the Society of Neurological Surgeons (CAST Certification). TMH is the only facility in the region with such highly trained and experienced neurosurgeons. The CAST Neuroendovascular Certification is generally accepted as the highest level of certification for Neuroendovascular Surgery, and the Society of Neurointerventional Surgery endorses this CAST certification. No other physicians in the area have this certification, including those in Pensacola, FL, and Dothan, AL.

Drs. Lawson and Oliver are partners at Tallahassee Neurological Clinic, a multispecialty group practice of neurosurgeons, neurologists, and pain management physicians. Dr. Lawson has been in practice in Tallahassee since 2012, and he was the first neurosurgeon in the region to perform brain aneurysm coiling or thrombectomy for the treatment of acute stroke. He helped establish the TMH Neuroendovascular Lab and the TMH Comprehensive Stroke Center. Dr. Oliver joined Dr. Lawson in 2013. As of now they share call for Neuroendovascular services for the region. In 2017, we expect another endovascular neurosurgeon to begin in Tallahassee.

Fig. 1. Right MCA aneurysm prior to treatment.
Fig. 2. Right MCA aneurysm at 6 months post treatment with a novel stent, placed at the TMH Comprehensive Stroke Center.

The neurosurgeons at TNC have a robust neurosurgical research component that includes research in stroke and brain aneurysm treatment. Neuroendovascular Surgery is a rapidly evolving field, and devices that were made just 10 years ago are now obsolete. Drs. Lawson and Oliver are active in Neuroendovascular research and have several open trials for novel devices and treatments. We feel that offering access to cutting edge medical research is a key component to a successful Comprehensive Stroke Center.

For more information about the TMH Comprehensive Stroke Center, click here.