< Previous Among the conditions that health professionals treat on a regular basis, few are as serious, frequent or complex as a stroke. According to the CDC, someone in the U.S. suffers a stroke every 40 seconds. While some strokes are minor, and present with symptoms that pass, others can be life threatening and require emergency surgery. The CDC says that one in every six deaths from cardiovascular disease is due to a stroke. American Heart Month, which is observed each February, has helped to raise awareness of stroke risk. Yet some people may harbor one of two different heart conditions known as atrial fibrillation or patent foramen ovale that can also increase stroke risk. These conditions can cause clots to form directly in the heart that, once pumped into the arteries feeding the brain, may cause a blockage resulting in a stroke. Late last year, St. Clair Health held an online symposium dedicated largely to addressing techniques being used to treat people with these conditions who have either suffered a stroke or have a high risk of stroke. Dr. Maxim Hammer, M.D., chief of neurology; Dr. Kyle Buchanan, M.D., FACC, interventional cardiologist; Dr. Jeffrey Liu, M.D., FHRS, director of cardiac electrophysiology; and Dr. Andy Kiser, M.D., FACS, FACC, FCCP, chief of cardiac surgery, participated, delivering talks and answering questions in the days leading up to World Stroke Day on Oct. 29. According to Dr. Liu, atrial fibrillation is a condition characterized by chaotic impulses that result in the upper chambers of the heart contracting ineffectively. This can lead to the development of blood clots in a section of the heart known as the atrial appendage. While not everyone with atrial fibrillation is at risk of suffering a stroke, Dr. Liu said that some people - including those with cardiovascular disease - are more at risk than others. He said those most at risk are over 65 and have suffered a stroke previously. Other risk factors include high blood pressure and diabetes. He said that many patients with atrial fibrillation who have suffered a stroke tend to be prescribed a blood thinner. These patients often end up taking that blood thinner for a long time, possibly even for the rest of their lives. “The reason these medicines are so highly advertised is because there are just so many people with atrial fibrillation these days,” said Dr. Liu. “Although these blood thinners do a very good job of preventing blood clots and certainly have been shown time and again to decrease the risk of stroke, the cost of doing business with a blood thinner is - by virtue of thinning the blood - it also puts people at a higher risk of bleeding.” For patients with atrial fibrillation who are most at risk of a stroke and can’t take blood thinners, St. Clair Health is now performing a new procedure that involves inserting a plug called the Watchman into the atrial appendage to prevent future clots from forming. Doctors insert the plug through the femoral artery. According to Dr. Liu, the procedure takes about one to two hours to complete and requires only general anesthesia. Patients are usually discharged either the same day or next. The procedure was approved by the FDA in 2016 and Dr. Liu says it has been shown to be just as effective at reducing the risk of stroke as blood thinners, but without the downside of medication. By comparison, patent foramen ovale is diagnosed much more rarely. According to Dr. Buchanan, the reason this condition isn’t seen as often is because it’s so difficult to diagnose. It occurs when a hole in the septum separating the right and left ventricles in the heart fails to close. Typically, this hole, which is present at birth, disappears later in life. “For most people, a patent foramen ovale goes unnoticed or undiagnosed their entire life, as it has no significant impact on cardiac function and is not easily visible on standard cardiac testing,” said Dr. Buchanan. However, it is much more statistically significant among people who have suffered a cryptogenic stroke, which is a stroke that has no discernable cause. Dr. Buchanan said 40% of people who experience a stroke without a clear reason have a patent foramen ovale. For people with this condition, a stroke can occur when blood travels through the patent foramen ovale to the left side of the heart, carrying with it a blood clot that can then be pumped into the brain. Dr. Buchanan said that patients with patent foramen ovale who have suffered a stroke are traditionally treated with blood thinners. About 20 years ago, surgeons began utilizing a method to insert a device in either side of the patent foramen ovale to close it, but it wasn’t until recently that this procedure was shown to have benefits outweighing medications. “For about a 15-year period...we did not have great science to support closure of PFOs since blood thinning medication seemed to work just as well,” said Dr. Buchanan. In 2016, research and studies began to suggest that closure of the patent foramen ovale in certain clinical situations was better than just medications alone, he said. That year, the FDA approved one new device for the procedure and, in 2018, the agency approved a second device. St. Clair Health is now performing the procedure for people who are at risk of stroke due to patent foramen ovale. It takes about 30 to 60 minutes to complete with moderate sedation and, much like the Watchman, is inserted via the femoral artery. Patients require two hours of bed rest following and are discharged the same day or next. For more about procedures being used to address atrial fibrillation and patent foramen ovale, and to view the entire symposium, visit stclair.org/heart-stroke-symposium. St. Clair cardiologists discuss new procedures to lower stroke risk 30 • Allegheny West Magazine • January/February 2022PITTSBURGH PA PERMIT NO. 5605 Hughey Publications, LLC P.O. 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