World Renowned Neuro-Radiology Experts
...right here at Sacred Heart.
Teamwork is helping medical experts put Sacred Heart Medical Center on the map with head-turning research and cutting-edge medical procedures. New interventional radiology techniques—some offered nowhere else in the Spokane area—are making surgery safer and simpler for patients.
“This will take us into a new age of assessing how people can preserve the ability to think,” says Dr. Raabe, an interventional radiologist at Sacred Heart Medical Center.
The procedure, carotid stenting, is a minimally-invasive alternative to endarterectomy, a surgery involving an incision in the artery. Instead, doctors thread tiny devices through the circulatory system, from thigh to neck, before inflating a small balloon to push plaque into the carotid artery walls. A stent is a small, mesh scaffold that keeps the artery open.
But Dr. Raabe’s research team also used a filter to trap any plaque loosened in the procedure, which itself could trigger a stroke or cognitive decline. While the study isn’t over, early results amazed researchers.
“We’ve found a way to improve the lives of millions of people,” Dr. Raabe told reporters.
“It was really exciting,” says Sacred Heart's clinical research coordinator Lynn Dahlstrom.
“We had patients saying, ‘You know, I can see colors brighter and I’m not forgetting things like I was.’"
“And that’s not what we expected to hear,” adds Dahlstrom.
Sacred Heart’s interventional radiologists were attracting national attention even before the study, most recently with a unique team approach to surgery and interventional radiology.
“At the Inland Vascular Institute, we’re one of the first places in the country to bring vascular surgeons and interventional radiologists together as one team. Economically, we’re all under the same roof so we do what’s best for patients,” says Dr. Raabe. “We get calls every week from people wanting to duplicate what we have here."
for 9-year-old boy
One minute Ismael Rodriguez was playing in the dirt with his little sister. The next, the 9-year-old Othello boy ran to his mother, vomiting and screaming that his head hurt.
Consuelo Rodriguez gave him an over-the-counter painkiller, but the headache persisted. Medical tests revealed the alarming problem: a large hemorrhage in the back of Ismael’s brain.
Unbeknownst to his family, Ismael was born with a rare tangle of abnormal blood vessels resembling a small ball of yarn. The malformation ruptured, and only surgery would be able to repair the damage.
Ismael was flown to Sacred Heart Medical Center, where pediatric neurosurgeon David Gruber, MD, told the boy’s parents the surgery was risky. Ismael could be left with seizures, vision or speech problems, or weakness on one side of his body. He could also lose a lot of blood very quickly, a great concern to Consuelo. As a Jehovah’s Witness, she doesn’t believe in blood transfusions.
“These vessels are much more fragile than normal, and so the risk of them breaking and resulting in a catastrophic bleed is much higher,” says Dr. Gruber. “A 9-year-old boy can’t lose that much blood.”
Dr. Gruber was relieved to work with Chris Zylak, MD, an interventional neuro-radiologist who dramatically decreased the risk of blood loss before Dr. Gruber even began the five-hour surgery.
First, Dr. Zylak threaded a micro-catheter through an artery in Ismael’s leg up to the cluster of vessels, called an arterial venous malformation. Then he injected a substance he likens to model airplane glue, plugging the rupture. The procedure took just 32 minutes.
“The training Dr. Zylak has is unique. This is a difficult location to embolize, but he nailed it perfectly,” says Dr. Gruber. “I felt certain the surgery would be much safer [after this procedure].”
On March 2, a day after the rupture was plugged, Dr. Gruber removed the blood clot and malformation. Ismael’s family watched anxiously as he awoke from surgery. Soon he signaled for a piece of paper and wrote, “I’m hungry.”
Consuelo was elated. “The first thing I did was thank Jehovah for the health of my son. I thanked him for the brains the doctors had to be able to do that surgery.”
Ismael is back in his fourth-grade classroom, where he speaks and reasons as well as ever, Consuelo says. He’s playing outside again, although he says he can’t run as fast as before.
Ismael’s recovery has been phenomenal, says Dr. Gruber, who’s confident his strength will improve. “I think his prognosis is excellent.”
“We’re also working together in a larger collaborative effort with neurosurgeons, interventional radiologists, neurologists and vascular surgeons at Sacred Heart’s neuroscience center.”
The carotid stenting study team includes Sacred Heart Medical Center, Washington State University statistician Robert Short, and Inland Vascular Institute surgeons and interventional radiologists. Neuropsychologist Robert Burr conducted cognitive testing of patients.
Micro tools, major changes
Although radiologists now treat some problems once left to surgeons, the department nurtures collaboration over competition, says Dean Martz, MD, a neurosurgeon. “It brings specialists of different perspectives together. Two heads are always better than one when you’re figuring out how to take care of a complex problem.”
Together, surgeons and radiologists decide which procedure best meets a patient’s needs. In some cases, radiologists step in before surgery with minimally-invasive techniques to block arteries to brain tumors or vascular abnormalities.
“They’re able to diminish the amount of blood flowing into a problem,” says Dr. Martz. “A surgery where there’s less blood is always easier and safer.”
Last September, neurointerventional radiologist Chris Zylak, MD, joined the team, bringing his impressive skills to the specialty. “We’re very fortunate to have him and Dr. Raabe in the region, because otherwise people would have to travel to Seattle for some procedures,” says Dr. Martz.
One procedure Dr. Zylak brings to Spokane is a nonsurgical way to keep cerebral aneurysms—abnormal bulges in a blood vessel—from rupturing. The treatment, called coil embolization, usually involves threading a catheter from a leg artery up to the aneurysm.
Guided by X-ray, Dr. Zylak packs the aneurysm with coils of platinum thread, and then detaches them with an electrical charge. Because blood can no longer flow into the aneurysm, major surgery can be avoided.
Patients go home the next day, says Zylak. “It’s a significant difference in terms of patient recovery.”
Dr. Zylak, a native of Canada and avid golfer, moved to Spokane with his triathlete wife and three young children to join Dr. Raabe at Inland Imaging and Inland Vascular Institute. He was particularly attracted by the way surgeons and neuroradiologists work in tandem.
“There’s a collaboration here, with the ultimate goal of doing what’s best for the patient,” says Dr. Zylak, 36. “Patient care is held at the highest priority, and it’s done by specialists trained in those procedures. We are currently offering every available treatment to our neuro patients.”
Meanwhile, patients from Canada and across the U.S. are calling to ask about participating in the ongoing study, says Dahlstrom. While initial results included 30 patients, the study can enroll up to 100.
Also, in a larger, international study to validate those findings, Dr. Raabe and Dr. Burr will lead the neurocognitive portion of the U.S. trials, with other researchers participating in London and Paris.
Both Dr. Raabe and Dr. Zylak are quick to thank everyone from Sacred Heart administrators to colleagues for supporting their work.
“I can’t emphasize the teamwork enough,” says Dr. Raabe. “If Chris and I are doing anything great, it’s because we have tons of people working with us.”
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