쉐도잉 연습: Intracranial Atherosclerotic Disease (ICAD) | Cedars-Sinai - 영상으로 영어 말하기 배우기

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I am Dr. Michael Alexander.
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I'm a neurosurgeon and vice chair of neurosurgery at Cedars -Sinai Medical Center.
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ICAD is a term we use to describe cholesterol blockages in the brain arteries.
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So ICAD is an acronym for intracranial atherosclerotic disease, and that can cause strokes.
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Most of the people with ICAD have certain risk factors so they're smokers, they may have high cholesterol,
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diabetes, obesity, and sometimes a family history of cholesterol blockages in the arteries.
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So ICAD can affect any race or ethnicity.
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It has a higher incidence in Asians, Latinos, and African Americans.
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Some patients may have no symptoms from ICAD in the early stages, so when there's a small amount of cholesterol blockage, you may have no symptoms at all.
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As the blockage gets tighter and tighter, there's less blood flow getting to the brain.
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So patients may experience TIAs, which is a temporary type of stroke, where they may have temporary trouble with speaking,
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temporary numbness or weakness in their arms or legs, or problems with balance or dizziness.
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And those can be the early warning signs of ICAD.
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Later on in the disease, patients may have a stroke which may have those similar symptoms where they have permanent problems,
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speaking, permanent weakness, etc. And those are the symptoms we want to prevent with some of the treatments that we have.
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Cedars -Sinai has been assessing and treating patients with ICAD for many years.
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We were one of the first centers to have high resolution MRA imaging of the brain
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and what What that does is it specifically looks at the brain arteries with contrast using dye
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to see if there's any inflammation of the cholesterol plaque and see if patients are at high risk for having further strokes.
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We are also one of the first centers to run major national trials looking at stenting for ICAD.
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So trying to open up the blocked arteries in the brain with stents
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and using these techniques to prevent more strokes in the future.
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So Cedars -Sinai, we ran the first two FDA approved trials in the last decade called the WEAVE trial
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and the WOVEN trial to look at stenting in patients who have high degree blockages in their brain arteries.
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So when a patient's referred to us, we have a team approach to treating them or assessing them.
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So the stroke neurologist will do basic tests on their blood
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and perhaps some other imaging of the brain besides MRI such as CT perfusion
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which is a CAT scan where we look at the blood flow to the brain to see
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if there's actually compromised blood flow in the area of the blocked artery.
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The neurosurgeons, neurointerventionalists, and neuroradiologists all help participate in both the assessment
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and treatment of the patient so it's a true team approach.
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For most patients, this treatment prevents or reduces the number of strokes patients will have in the future.
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For some patients, that actually improves their neurologic condition.
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So particularly patients who present with dizziness or problems with balance, sometimes they have low blood flow to the back part of the brain called the cerebellum.
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And for those patients, as soon as they have increased blood flow, they stop having dizziness and they have better balance just with the treatment.
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I think some of the questions that patients and their families have about ICAD is, number one, are they a candidate for treatment?
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Because many patients are told that they aren't a candidate for any other treatment other than medical therapy, and that's not true.
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So they want to know, are they a candidate?
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Secondly, patients want to know what the risks are with this type of treatment.
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There's risks with any type of treatment, even just medical therapy alone.
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But what we found from the WEAVE trial is
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that the risk of doing the stent treatment is actually very low now compared to where it was 10 years ago.
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And so it is in a very good safety range for treatment as long as the patient meets the criteria.
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For patients to learn more about ICAD, the best resource is going on the Cedars -Sinai website where they can read more about how it's diagnosed,
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what the symptoms are, and what the treatment options are.

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