Every 45 seconds, someone in the United States experiences the destructive effects of a stroke.
Alexander Khalessi, MD
Rarely does the disease strike the young. However, in 2012, a 34-year–old mother arrived at UC San Diego Health System unable to speak, paralyzed on her right side and unconscious. On the National Institutes of Health Stroke Scale, her score was a grim 25; strokes scored over 15 are usually either severely disabling or fatal.
“The patient had fibromuscular dysplasia, a genetic disease that causes weakening or a tear in the wall of arteries that reach the brain,” said Alexander Khalessi, MD, director of endovascular neurosurgery at UC San Diego Health System. “The patient’s dominant carotid artery was torn and completely blocked — what we call a spiral dissection. In effect, her brain was being starved of blood and oxygen.”
Khalessi and his team opted to rebuild the artery through an endovascular approach, a minimally invasive procedure in which a catheter is inserted into the blood vessel. Normally, catheters and wires fed from an artery in the leg are used to cross the blockage and reconstruct the artery using a series of stents. This patient, however, required a more elaborate approach; her artery was so damaged that crossing the blockage from below was impossible.
“With a blocked artery, every second counts. Her life was in the balance, so we were forced into the unconventional,” said Khalessi. The surgeons placed a second catheter in the opposite carotid artery, guiding it through small connections between the arteries of the brain itself, and down the damaged left carotid to cross the damaged area from above — literally going over the top.
During the two-hour procedure, Khalessi successfully reconstructed the entire length of the left carotid artery using four telescoping stents. The gateway to the repair was the anterior communicating artery, a very tiny artery deep in the brain.
Within 24 hours, the patient was speaking. Today, she has fully recovered and returned to caring for her children.
Changing How Surgery Is Done
"With a blocked artery, every second counts."
- Alexander Khalessi, MD
The Comprehensive Stroke Center at UC San Diego Health System is one of only a few locations in the country to offer complete surgical and neuro-critical care for complex stroke patients.
“Beyond the availability of novel devices that have revolutionized our ability to open arteries in the brain, recent studies demonstrate that restoration of blood flow is only one piece of the puzzle,” said Khalessi. “The benefits of having an entire team that rapidly makes the diagnosis with sophisticated imaging and gets the patient to the angiography suite quickly cannot be overstated.”
The Center for the Future of Surgery at the UCSD School of Medicine further allows Khalessi to direct physician training courses for surgical devices central to advancements in stroke care. Beyond serving as a national destination for pre-clinical and simulator training, the Center has become an important clearinghouse for new device development in the field.
“Working here goes beyond providing leadingedge care to our patients,” said Khalessi. “I value training the next generation of surgeons and changing the way surgery is done. From driving national conversations in health care delivery to developing new techniques and devices, we are given the opportunity — every day — to make medicine better.”
To learn more about how you can help us redefine medicine and support our Future of Care initiative, visit futureofcare.ucsd.edu or call 858-246-1568.