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Dr. Victor D’Addio, a vascular surgeon with VIVA, prepares for a procedure

From ultrasound tests to complex vascular procedures, Virginia Interventional & Vascular Associates (VIVA) provides patients with comprehensive services that assist in preventing strokes.

One of the main causes of stroke is carotid artery stenosis, which is a buildup of plaque in the carotid artery in the neck supplying blood to the brain. VIVA offers screening, diagnosis, and management for this condition. Three of the procedures available for stroke prevention are carotid endarterectomy, carotid stenting, and carotid duplex ultrasound testing.

Carotid endarterectomy is an open surgical procedure that removes the blockage to help prevent a stroke. Larry Koenig III, MD, and Victor J. D’Addio, MD, FACS, are board-certified, fellowship-trained vascular surgeons with VIVA who perform the surgery at Mary Washington Hospital.

Dr. Koenig said patients considered for the surgery either have had a previous stroke, suffered a transient ischemic attack (TIA), which is a warning stroke that usually does no permanent damage, or have a blockage identified through medical imaging tests.

Though they occur in a relatively small number of cases, there is a risk that a patient could have a stroke during surgery. The Society for Vascular Surgery estimates that strokes occur in 2–3% of patients with no pre-procedure symptoms, and in 5–7% of patients who have had a previous stroke, mini-stroke, or TIA.

VIVA physicians have a high success rate with the procedure and perform roughly 75–100 of the surgeries a year, Dr. Koenig noted.

“Once the procedure is done, the risk of having a stroke suddenly drops. It almost resets the clock for the patient,” he said.

After a brief hospital stay, patients return to VIVA’s outpatient facility periodically for follow-up appointments. There, painless carotid duplex ultrasound testing can help detect whether or not the patient has developed additional blockages requiring medical attention.

Carotid stenting is an alternative to endarterectomy for patients who are poor candidates for open surgery based on their physical condition or anatomy, Dr. Koenig noted. It is less invasive than open surgery and successful in most cases but also carries a small risk of stroke.

The vascular surgeon makes a tiny incision in the patient’s thigh and threads a catheter through the femoral artery to the carotid artery in the neck. There, a small wire stent is placed over the blockage to keep the artery open.

Dr. Koenig performs carotid stenting procedures at Mary Washington Hospital. In a recent case, Dr. Koenig recalled, a man who had a carotid endarterectomy elsewhere more than a decade ago was admitted to the hospital for an unrelated condition and then suffered a TIA before his planned discharge. After a computed tomographic (CT) scan of his neck revealed that the patient had developed another severe carotid blockage, Dr. Koenig successfully performed a carotid stenting to reopen the artery.

Carotid stenting patients also are monitored through follow-up appointments at VIVA’s outpatient facility. There, patients who are suspected of having carotid blockages or are being monitored for them are tested by registered vascular technologists in VIVA’s accredited vascular lab.

A transducer is placed against the patient’s neck, enabling the carotid duplex ultrasound technology to “see” and “hear” the carotid artery blood flow. The patient’s VIVA physician then interprets the results and discusses them with the patient or with the referring physician involved in the case.

For more information, call VIVA at (540) 654-9118 or visit http://vivassociates.com/.