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Procedure saves teen after rare carotid trauma

Barbara Albani, M.D., Amanda Nicholas and Gregg Zoarski, M.D.

Amanda Nicholas flanked by Barbara Albani, M.D., and Gregg Zoarski, M.D., two of the surgeons who saved her life after she experienced a rare injury to her carotid artery.

Neurointerventionalist Gregg Zoarski, M.D.’s recent surgical grand rounds lecture on carotid artery injuries focused on how to repair traumatic injuries to these vital vessels that supply blood to the brain.

“It’s a very, very rare injury, and it’s something you may not see in an entire year,” said Christiana Care Trauma Center Medical Director Mark D. Cipolle, M.D., one of the doctors who listened to Dr. Zoarski’s lecture.

Dr. Cipolle probably should have knocked on wood.

Only one hour after Dr. Zoarski’s lecture ended, a patient with an injured carotid artery was airlifted to Christiana Hospital’s Level 1 Trauma Center from Bayhealth’s Kent General Hospital in Dover.

Amanda Nicholas, 19, of Camden-Wyoming, received a carotid artery injury from her shoulder-harness strap in a car collision.

While Amanda was fully conscious, Bayhealth surgeon Assar Rather, M.D., observed unexpected changes in his patient the morning after the accident. Nicholas’s face began drooping, and her speech started slurring, indicating that she was having a stroke. A CT angiogram confirmed that Nicholas was losing blood flow to her brain.

“I got alarmed because she is a young patient,” said Dr. Rather. “It is one of those injuries that, if not detected in a short time period, can cause long-term problems, such as disability or death. Any delay is dangerous.”

Dr. Rather believed Nicholas needed a stent implanted in her carotid artery—an operation that could be completed only at a hospital with a neurointensive care unit and neurointerventional specialists. He referred Nicholas to Christiana Hospital.

“I wanted the stents because I wanted every chance for Nicholas to get better,” Dr. Rather said.

Nicholas arrived at Christiana Hospital at about 11 a.m., only three hours after Dr. Zoarski’s lecture ended. Dr. Cipolle immediately directed Nicholas’s case to the neurointensive care unit, so Dr. Zoarski could implant a stent in her carotid artery and treat the clots that had blocked the small but vital vessels to her brain.

“This case was amazing in that I knew during the lecture that I might not see one of these sorts of cases in the entire year and I then saw one in the next hour,” Dr. Cipolle said.

During the three-hour surgery, Dr. Zoarski worked along with Barbara J. Albani, M.D., Christiana Care’s director of neurointerventional surgery, to place a stent into Nicholas’s carotid artery, which was almost completely blocked by the injury. The stent opened the carotid artery and helped restore normal blood flow to Nicholas’s brain. The doctors also removed clots from her body with a minimally invasive medical device known as a Penumbra Stroke System in combination with the clot-busting drug known as tPA.

“The stent was key to her survival and complete recovery,” Dr. Zoarski said. “It is a coincidence to give a lecture at 7 a.m. on that subject and then do the same surgery a few hours later.”

Nicholas left Christiana Hospital after a two-night stay. She returned for a follow-up visit on Wednesday, Nov. 23, and took the opportunity to thank the health care team that saved her life.

“I’m grateful that I don’t have brain damage and I’m not dead,” Nicholas said. “I’m grateful that they did the surgery and that I’m fine.”

Neurointerventional surgery

The Christiana Care Neurointerventional Surgery team provides 24/7 minimally invasive services and treatments in a state-of-the-art neurointerventional surgery suite that is unmatched in Delaware.

The team not only provides technologically advanced treatment of strokes, but can perform minimally invasive procedures to treat aneurysms and other conditions affecting the brain and spine that were once only treatable through open surgery. The advantages of neurointerventional procedures over traditional open surgery include a shorter recovery time and less pain during recovery.

Neurointerventional radiologists, including Barbara Albani, M.D., Gregg Zoarski, M.D., and Sudhakar Satti, M.D., use sophisticated technology to see inside the body in real time and manipulate tiny catheters through the patient’s blood vessels. This enables them to break up a blood clots inside the brain or to eliminate blood flow in an aneurysm to prevent it from bursting. Minimally invasive treatments are also used by neurointerventional radiologists to treat spinal conditions without exposing the spinal column.

Christiana Care Health System   |   PO Box 1668, Wilmington, DE 19899   |   800-693-2273   |   www.christianacare.org