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Anyone who has a risk factor for atherosclerosis or hardening of the arteries. Anyone who has cardiac disease. A patient with hypertension, a patient with a history of smoking, a patient with diabetes: they are all risk factors for stroke. Anyone with these risk factors should be tested. Otherwise anyone over 65 should have one screening, perhaps once a year, and have it done so that the we know that the arteries are clean and we are all happy. Let's say there is a 50% block.

Stenosis refers to a narrowing of the opening in the spine through which the spinal cord and nerves pass. It can be congenital (something you are born with) or, more often, due to degenerative disease. Most patients present with leg pain when walking. Spinal stenosis is a narrowing of the space that the nerves occupy inside the spinal canal. Bone spurs, disc herniations, tumors, or the buckling of ligaments inside the spinal canal can produce this.

Spinal stenosis can be treated initially by decreasing the inflammation and the swelling on the nerves so that they fit a little bit better in the space that is still available. When there is no response to conservative treatment, then surgical treatment may be required. Surgical treatment for spinal stenosis consists of removing the material that is producing the stenosis, such as bone spurs or pieces of bone from fractures. Spinal stenosis is a slowly progressive condition.

Carotid Stenting basically involves the same technique as for coronary angioplasty. Initially, we dilate the lesion with balloon angioplasty and then place a stent across the blockage. The whole procedure takes only half an hour to 45 minutes and the risks are considerably less than carotid surgery, even though carotid stenting is just evolving. Further refinement in equipment and technique greatly reduces the risks.

Yes, our techniques work very well for spinal stenosis and other disorders that relate to nerves impinged by bone or disc. We can remove small amounts of disk and bone that are impinging upon the spinal cord. The removal of this bone and soft tissue is under direct observation to assure that the nerve impingement is resolved. You are awake during the procedure and can alert us to whether the problem is resolved or not.

Take a high resolution (> 7 mHz) ultrasound linear probe and visualize the carotid arteries on both sides including the proximal portions of the internal and external carotid artery (it does not matter, if you mistake the ICA for the ECA in this case !). Look carefully for plaques defined as intimal thickening > 1.4 mm. Any plaque measuring > 1.0 has to be measured exactly (e.g. 2.3 mm) and the sum of the vertical diameter of these plaques from both sides is the plaque score.

Arthritis, (boney overgrowth) that occurs in the facet joints can compress single or multiple nerve roots causing spinal claudication, which is the feeling of leg weakness with activity. Essentially, the boney growth blocks blood flow to the nerves, causing heaviness in the legs, ultimately causing the patient to sit down to recover. This can also lead to spinal instability due to the facet joint compromise from the arthritis.

Take a high resolution (> 7 mHz) ultrasound linear probe and visualize the intima before the carotid bulb for a length of 1.0-2.0 cm. Using the trace function, measure the area of the intima, that is clearly visible. Divide this area by the length of the area to obtain the mean intimal thickness. Perform measurements on both sides. Use the side with the higher value. Store all images and calculations on a back up media.

Blockage or narrowing of the arteries in the neck can predispose patients to suffer a stroke which occurs when a portion of the brain receives inadequate blood flow and dies. Since it is very difficult to reverse the damage once it has occurred, successful management of this condition requires early recognition of the disease, often even before symptoms occur, and prompt, safe treatment.

The Carotid arteries are located on both sides of the neck as they conduct a majority of the blood to the brain. Blockage due to atherosclerosis or cholesterol build up in the carotid arteries can result in stroke. Blockage, or “stenosis”, in the neck or carotid arteries accounts for over 200,000 strokes annually in this country. These are strokes that can be avoided if the blockages are found beforehand.

Physicians can often hear a rushing sound or “bruit” over the neck when listening during physical exam. Some people have “brain attacks” or TIA’s (Transient Ischemic Attack) before a major stroke that can alert their doctors to test the carotid arteries. Still, most people remain asymptomatic and only through screening tests such as carotid duplex ultrasound exam are we able to find the blockages.

This is by far the commonest cause of secondary hypertension, and accounts for about 3 per cent of all cases of hypertension. It's caused by a narrowing in one or both renal (kidney) arteries. This reduces the blood pressure and flow in the kidney, which responds by secreting a hormone called renin, which enters the blood stream and leads to the formation of a second hormone (angiotensin), which causes the blood pressure to go up. This helps to restore the flow to the blocked kidney.

I've been off work for almost a year with chronic low back pain. I'm out of sick leave and disability. Now I'm losing pension benefits. Is it worth the cost of having surgery to fuse the spine? There's no guarantee I'll get back to work, but I feel like I've got to do something.

However, now as we speak there is now a new treatment called stenting. As we use a stent in the arteries in the heart, we are now stenting the carotid arteries. We are one of the few centers where it is being done. And there are 70 centers in the country that are testing whether stenting is better than the operation. The operation has been highly successful and the risk of complications is only 1 to 3 per cent.