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A New Option "Opens Up" for High-Risk Stroke Patients
Following a heart attack in 1991,
Martha Wickham had an angioplasty
at Jersey Shore University Medical
Center performed by cardiologist Nelson
LaMarche, M.D. Since then, she has diligently
followed his advice to quit smoking,
watch her diet, and stay on prescribed
medications. Yet a regular doctor's visit last
year raised suspicions when an ultrasound
and CT (computed tomography) scan
revealed she had a carotid artery blockage.
Despite having a mother and sister who
had strokes, Martha still was surprised to
learn her carotid artery had a 90 percent
blockage. "I felt fine and had no symptoms,"
says the 81-year-old Brick resident.
"It's scary to think that a stroke could have
happened at any time."
Neurologist Stephen Martino, M.D., the
director of Jersey Shore's nationally certified
Stroke Center, discussed the options
with Martha: a traditional carotid surgical
approach or a newer option called carotid
artery stenting. At Jersey Shore, only
Dr. LaMarche and one other health care
professional have received the special
training needed to do this.
Knowing that Dr. LaMarche would
perform the procedure made the choice
of treatment easy for Martha. "After being in his care for 16 years, I wouldn't think of
going to anyone else," she says. "Besides
being a great doctor, he puts me at ease
and always takes as much time with me as I
need. I have much faith in him."
Carotid stenting is best suited for surgical
high-risk patients. "Martha has an extensive
cardiac history," says Dr. LaMarche. "Other
conditions qualifying a patient as high risk
could be a previous surgery or radiation
therapy to the neck area."
For carotid stenting, the physician first
places a filter just beyond the blockage in
the carotid artery. If a piece of the blockage
becomes dislodged, the filter captures it.
A balloon catheter is then inflated to open
the blockage, followed by positioning the
mesh stent to ensure it stays open. "We've
had such tremendous success with carotid
stenting that surgeons are starting to refer
extremely high-risk cases for consideration,"
says Dr. LaMarche.
After the surgery, Martha has greater
peace of mind knowing the blockage has
been fixed. "The key is to know your
family history and stay on top of your
health with doctors whom you trust," she
says. "That's the lesson I tell my children
and grandchildren."
 – John Shaffer
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