AUB Medical Center offers new surgical therapy for stroke

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Neurosurgeon Joseph Salame has successfully treated three patients who presented with several strokes that did not respond to drug therapy. This new technique involves endovascular therapy that uses angioplasty and stenting with an FDA-approved stent.

Endovascular therapy is a technique that involves entry into blood vessels with a catheter, usually to place a metallic stent, or open tube, to keep the vessels open. Angioplasty is the part of the procedure that uses a catheter, which has a balloon tip, in order to widen the blood vessel before the stent is inserted.

While endovascular therapy has been in use for a few decades in heart surgery, its use in brain surgery is much more recent. Prior to that, patients with stroke had only one of two options: drug therapy or very high-risk bypass surgery. Now, patients have the option to be treated with the generally safe and high-success-rate endovascular therapy.

Salame, who joined AUBMC in July 2007, specializes in microvascular neurosurgery and endovascular therapy, having performed more than 500 procedures in Canada and the United States. He received his medical degree from the University of Montreal in Canada and then went on to specialize in neurosurgery at Sherbrooke University in Canada. He then did his subspecialty of endovascular neurosurgery in Miami, Florida. He is one of the very first neurosurgeons in the region to perform this endovascular brain surgery.

'Endovascular therapy is an exciting development in the treatment of stroke,' he said, 'and I am really eager to offer this new technology to Lebanese patients.'

Stroke, which is the sudden death of brain cells due to an interrupted flow of blood and oxygen to the brain, is a debilitating disease and represents the second cause of death in developed countries. Depending on the region of the brain affected, a stroke may cause paralysis, speech impairment, loss of memory and reasoning ability, coma, or death.

Ischemic stroke, which occurs as a result of a blocked artery in the neck or head, represents more than 80% of stroke, while the rest are due to hemorrhagic stroke, explained Dr. Salame.

Intracranial atherosclerotic disease (IAD), which is the narrowing of arteries inside the skull that supply blood to the brain, is associated with an increased risk of stroke.

The yearly stroke risk in patients with intracranial atherosclerosis ranges from 7 to 30 percent, added Dr. Salame.

'People with IAD are usually prescribed blood-thinning agents such as anticoagulants, antiplatelets, and cholesterol-lowering agents, in order to prevent stroke,' he said. 'But those who do not respond to drug therapy could be good candidates for endovascular therapies such as intracranial angioplasty and stenting which represent a promising treatment option.'