Vol. 8 No. 1
March 1998

Insuring Quality Community Healthcare

Winthrop's Advance Directive Initiative

The Winthrop South Nassau University Health System Opens Homecare*America Superstore in Mineola

Winthrop Welcomes Three New Directors

Winthrop Opens a Second, Fully Monitored Neurosurgical Intermediate Care Unit

Winthrop's $12 Million New Life Center is on Track for July, l998

Winthrop's Long Island Regional Poison Control Center Observes Fifth Anniversary of Averting Danger, Saving Lives

Patient Unit is Dedicated to the Management of Chronic Obstructive Pulmonary Disease

Long Island's First Dual Chamber Defibrillator is Implanted in Winthrop's Electrophysiology Lab

Report from The Heart Institute at Winthrop: Third Cardiac Catheterization Lab is Authorized by State Department of Health

Winthrop's Artificial Heart Device Program: A Revolutionary Treatment for End-Stage Heart Disease Patients

Winthrop's Dialysis Centers Receive National Award for Patient Encouragement - One of Only Six Programs in the United States to be Recognized

Endoscopic Ultrasound: On The Forefront of Technology

Long Island Chapter of Impotents Anonymous Meets at Winthrop, Filling an Intimate Need ---Confidentially

Winthrop's Stem Cell Autologous Transplantation Therapy Program Saves a Life - And Can Save More!

Winthrop Adds Powerful New Radiological Intervention

Winthrop Auxilians Donate Service, Talent, and Creative Fundraising

Winthrop's Division of Reproductive Medicine Makes Parenthood Possible

Dialysis is technology...but caring is an art.

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Orlando Ortiz, MD, MBA is the first interventional neuroradiologist at Winthrop, and, it is believed, only the second on Long Island, to perform these new, lifesaving endovascular interventions.

Orlando Ortiz, MD, MBA, Attending Interventional Neuroradiologist, performs new, lifesaving endovascular interventions, using a coaxial catheter system. Here, Dr. Ortiz reviews the results of a patient's brain scan. ults of a patient's brain scan.
A new and dramatic neurovascular intervention can now be provided at Winthrop-University Hospital, with the acquisition of sophisticated coaxial microcatheter systems and state-of-the-art radiographic guidance technology. Orlando Ortiz, MD, MBA, an Attending on Winthrop's Radiology staff, will be directing the new program.

Stroke victims and patients with other vascular lesions should be treated immediately, before the damage becomes catastrophic and irreversible. Intra-arterial therapy must be administered within six hours of the onset of symptoms. With the procedures now available at Winthrop, a Level I Regional Trauma Center, community residents and others transferred to Winthrop will receive lifesaving neurovascular interventions immediately. Previously, travel or emergency helicopter transfer to New York City medical centers would have been necessary to access these procedures.

Unlike most heart attacks, which make their presence known by excruciating pain and shortness of breath, many cerebrovascular and neurological problems develop insidiously, without symptoms - ultimately manifesting themselves through alarming episodes, such as seizures, severe headaches, loss of consciousness, or a brain attack, commonly known as a "stroke." In some cases, sudden visual, hearing, or gait problems might occasion a physician visit. When the Primary Care Physician recommends a CT scan, MRI, or angiogram, the problem is plainly visualized by the radiologist.

Dr. Ortiz displays the coaxial catheter system used in endovascular interventions.
Brain attacks deprive the brain of blood and oxygen, which can result in paralysis, speech impairment, loss of vision, and even death. Cerebrovascular and neurological conditions are not age-related. Aneurysms, for instance, do not respect age. Otherwise healthy young people have been known to die from a ruptured aneurysm.

The sophisticated new technique provided by Dr. Ortiz can be effective in treating many cerebrovascular and neurological problems, including aneurysms, blood clots, lesions, tumors, or clusters of abnormal vessels which may have grown in the brain or spinal cord. These problems can be congenital, or can develop slowly and asymptomatically during the first decades of life.

Dr. Ortiz explains that some individuals are born with a propensity to develop clumps of weak, abnormal blood vessels on the brain, which can suddenly start to bleed. Even without bleeding, these anomalous vessels divert needed blood flow from other, normal parts of the brain, and must be treated.

Through neurovascular intervention, aberrant blood vessels and tumors can be occluded, or starved of their blood supply, greatly reducing their size - which facilitates their surgical resection or removal. The subsequent surgeries are shorter, with less loss of blood - enhancing recovery. Dr. Ortiz cites one instance in which the resection of a brain tumor "the size of a baseball" required only two hours of surgery, rather than the more typical eight hours.

Before: These blood vessels in the brain branch off into a vascular malformation, which can be "starved" through endovascular intervention.

After: Immediately after the intervention, the big tangle of abnormal veins is gone!
The merit of the interventional procedure is magnified when a brain lesion has been declared inoperable, due to its location in a normally unreachable part of the brain.

"Embolization can convert an inoperable tumor to an operable one," notes Dr. Ortiz. "Large tumors can also be reduced by this intervention, making them more responsive to radiation therapy."

The intervention requires the simultaneous use of multiple catheters - thin, flexible tubes which can be radiographically guided through blood vessels to the head, neck, or spine. A short catheter, or sheath, is placed within the femoral artery at the groin. Next, a guiding catheter is advanced through the sheath, under radiographic guidance, within the body's major arteries. A microcatheter, measuring only a few millimeters in diameter, can then be advanced through the guiding catheter. From there, it can be conducted into deep, previously impenetrable areas of the brain or spine, to deliver medication which accomplishes specific tasks. Upon reaching the desired destination, the guidewire is removed.

Through this coaxial system of catheters, clot-busting drugs can be administered intra-arterially, dissolving the clot within a blood vessel, and allowing the free flow of blood to the brain. If the patient has a tumor or an aberrant collection of blood vessels growing in the brain, Dr. Ortiz injects these structures, via the catheter system, with microparticles of polyvinyl alcohol - so tiny that they resemble salt granules - which block blood flow. The anomaly atrophies due to lack of blood, making the surgeon's "removal" job easier, faster, and safer for the patient. Even if surgery is contraindicated, the depleted abnormality is usually more amenable to treatment with radiation therapy.

"Tumors are smart. If their original supply of blood is cut off, they will develop new routes to feed themselves. That's why tumors must be removed or rendered harmless," says Dr. Ortiz.
"Whether through surgery, radiation, chemotherapy or a combination of any or all three, tumors must be removed or rendered harmless," Dr. Ortiz observes.

Winthrop patients with diagnosed or emergent neurovascular problems, and their families, can be reassured that Winthrop's teams of interventional radiologists, neurosurgeons, vascular surgeons, neurologists, and radiation oncologists have a powerful new technique in their armamentarium.

"The start-up of neurovascular interventions is a major step toward the development of a comprehensive Neurovascular Institute at Winthrop - to include preventive measures, diagnostic and therapeutic treatments, and rehabilitative functions, providing complete cerebrovascular care for our patients," Dr. Ortiz concludes. He can be reached at 516/663-8636.

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