Attacking a Monster Clot! -- In Depth Interview with Dr. Warren Swee

   
Warren Swee, MD, MPH, a Vascular and Interventional Radiologist at South Florida Vascular Associates, in Coconut Creek, FL, talks about a state-of-the-art device that melted away a potential killer.

What is DVT?

Dr. Swee: DVT or a deep vein thrombosis is essentially a clot that forms in the deep veins of the leg. Initially it will present as pain and swelling in the leg, which can increase over several days. It’s usually identified with a simple test in which an ultrasound probe is placed over the veins of the leg. DVT is a tremendous public health problem in the United States with almost six thousand cases diagnosed every year. Although the initial problem with the pain and swelling can resolve it, it also places patients at significant risk of a pulmonary embolism, which is when a part of that clot breaks off and travels to the lungs and that can be life threatening. It’s estimated that up to a hundred thousand patients every year will die of pulmonary embolism.
What does a pulmonary embolism do?
Dr. Swee: It breaks off from the legs and travels up the pelvis through the abdomen, through the heart and into the pulmonary artery, which is the main vessel that supplies oxygen to the lungs for transport. Without blood going to your lungs it can be fatal.
How often do you see DVT patients coming in here?
Dr. Swee: We see DVT patients quite frequently. Typically they’re relatively simple DVT’s with an isolated clot behind the knee or in a portion of the vessel along the thigh. In rarer cases the clot can travel up across the thigh in to the pelvis and even in to the abdomen. Those are much more severe cases.
What is the size of a normal clot?
Dr. Swee: Typically anywhere from an inch to six inches or so is-- would be a typical clot size.
The clot basically cuts off the circulation to the rest of the vein?
Dr. Swee: Correct. It prevents drainage of the blood from the leg from going up through that vessel. Usually that’s what causes the swelling because you’re unable to drain blood from the leg, but over time if a patient is placed on the proper anticoagulation, some of the clot will melt away on its own. The body will form collateral or side channels around the blocked segments.
How do you take care of the clot?
Dr. Swee: Most cases of deep vein thrombosis are treated with just blood thinners. The pain and swelling usually will resolve within a week or so.
As long as you catch it early enough the danger might be minimized?
Dr. Swee: The blood thinners is twofold. One is to prevent the clot from becoming bigger and second to help stabilize the clot so that pieces don’t break off and go to the lungs.
What is the biggest one you’ve seen?
Dr. Swee: Mr. Cunha has a very large clot. His is about a two and a half foot clot that starts below the level of the knee and extends all the way up his thigh into his pelvis and into the lower abdomen. Those clots don’t respond as well to blood thinners because they’re so massive.
How often do you see that?
Dr. Swee: We probably see that maybe once every few months, if that.
How do you survive when you have a clot that big?
Dr. Swee: The blood is no longer liquid. It’s solidified into almost a jelly like substance, and plugs up the vessels instead of allowing flow. It causes immediate swelling but the body does have a lot of capacity to somehow move blood around the actual blockage through their side channels.
So when you get to a point where it’s two and a half feet long what’s the next attack?
Dr Swee: Those patients are in particular at risk of throwing clots to their lungs. If they are treated only with conservative measures, they tend to have debilitating pain and swelling in their legs often for the rest of their lives. They can develop something called post thrombotic syndrome, in which the clot damages valves within the veins. With damage to the valves, it causes you to have this horrendous pain and swelling. What we can do now is use a catheter called the EKOS catheter, which has really revolutionized the way we as interventional treat large blood clots. A small catheter is essentially inserted through the skin into the clotted vessel and positioned there. Within a coaxial system, there is a wire, which is an ultrasound wire, and together this allows simultaneous deliver of ultrasound energy and clot busting medications to allow breaking up the clot much more quickly and safely compared to standard techniques.
How does the EKOS work?
Dr. Swee: The catheter itself has hundreds of holes in it which allow the clot buster to be delivered directly in to the clot. At the same time the ultrasound core wire delivers ultrasound energy, which causes a vibration, which allows the clot busting medication to better penetrate the clot.
In Mr. Cunha's case, if this wasn’t around what would be the other option?
Dr. Swee: The standard technique is to put a catheter in with a lot of side holes, which is can also deliver clot busting medication but without the ultrasound energy. That can work also, but it can take almost double the time. Time counts when we’re treating clot because we’re delivering a very powerful clot busting medication that has a lot of side effects. There could be bleeding from other parts of your body and the worse scenario would be bleeding into your brain, which can be fatal.
How often have you been able to use this now?
Dr. Swee: I’ve used this catheter in about a half a dozen cases, including clot in the leg vessels, and also clot up in the pulmonary arteries. When a clot breaks off and becomes a pulmonary embolism, the catheter can actually be advanced all the way up through the heart from the groin and positioned inside the pulmonary artery.
What is the clot busting drug that you use?
Dr. Swee: There are several different ones that can be used. The one that we typically use is called TPA or tissue plasma activator.
Once Mr. Cunha was diagnosed with his huge blood clot, what was the step after that?
Dr. Swee: Once we reviewed some more imaging we found out that the clot was not just in his leg but it actually went up in to his pelvis and abdomen. We performed the procedure in a hospital endovascular suite under an x-ray machine. He essentially was positioned on his stomach to allow access to his vein right behind his knee. Using ultrasound guidance we advanced the needle into that vein and then through that hole threaded the catheter into the clot. We positioned it under x-ray guidance and then started dripping the clot busting medication into the clot to dissolve it. In Mr.Cunha’s case because this clot was almost five weeks old, it took longer than most cases. It took two days to finally melt the clot away. But he had a fantastic result and dramatic improvement in his leg swelling and pain.
What was his recovery like?
Dr. Swee: The patient is transported to the ICU where they’re monitored carefully for any complications from the clot busting medication. If they do well then they’re brought down the next morning and then we do a check by injecting x-ray dye in to the vessel to see how much clot is still there. If there’s still clot then we’ll send the patient back up to ICU and continue the drip and the ultrasound energy and then bring them back the next day.
Between the ICU and the actual procedure how long are you busting the clot?
Dr. Swee: The actual procedure to get the catheter in is actually pretty quick. It takes about twenty minutes or so to get the catheter where it needs to be. The catheter stays inside the body until the clot is dissolved totally.
What added benefit does the ultrasound give you?
De. Swee: The ultrasound allows the clot busting medication that’s being dripped through the catheter to better penetrate the clot and allows for more surface area between the clot busting medication and the clot. That essentially allows for much quicker dissolving of the clot and decreases the overall amount of clot busting medication that we need to use.
What are the risks?
Dr. Swee: This actually allows us to use this sort of treatment on patients that previously were not candidates, because they couldn’t tolerate several days of clot busting medication. By using this device we can decrease the time it takes to do the procedure and also the amount of clot busting medication.
It’s pretty amazing that Mr. Cunha was left with no disability.
Dr. Swee: Over five weeks he was basically hobbling around and just in constant pain. But about a day or two after the clot was dissolved he was almost back to normal.
What was his recovery time?
Dr. Swee: Following the procedure he stayed in the hospital for an additional week in order to thin his blood to an appropriate level and then after that he was sent home and walking quite comfortably.
Has he had to take anything since?
Dr. Swee: He’s going to be on lifelong blood thinners.
Once you’ve had a clot that big, are you at risk for another?
Dr. Swee: The biggest risk for him is re-developing a clot in the same place.
What has it done to the vein now? Having such a massive clot how stable is it?
Dr. Swee: The vein now that the clot has been melted away is very resilient. In his case his veins should essentially come back to their normal configuration. He may have some mild damage to the valves, but certainly not anywhere near the damage that would have been caused if the clot was not removed.

   

Carotid Artery Stenting

The Boynton Times

Local Surgeon Implants New Minimally Invasive Carotid Stent Device and Saves One Man's Life
Boynton Beach, FL. By the time Joseph Camiso was 73, he already had a six-vessel coronary bypass surgery. He had also undergone carotid artery surgery, called endartectomy, which is performed for patients whose carotid arteries have narrowed because of cholesterol buildup. The threat of stroke caused by clogged carotid arteries is not uncommon.

The endartectomy created a large scar on the left side of his neck, but more concerning was that the nerve supplying the left vocal cord was damaged leaving that side of his throat paralyzed.

“I sounded like a character from ‘The Godfather,’” said Mr. Comiso.

Unfortunately, his carotid artery on the right side was also dangerously narrowed and needed to be opened to prevent a stroke. Mr. Comiso and his wife, Marie, then visited an ear, nose, and throat specialist to discuss having an endartectomy for the right carotid artery, but the specialist told them that it was too dangerous. If the nerve supplying the right vocal cord was damaged from the incision, he would be unable to speak or breathe and an emergency tracheotomy tube would be needed.

“My doctor thought that I was too high risk to have another surgery because of the vocal cord paralysis,” he said.

Traditional carotid artery surgery can pose complications in healthier patients as well, including strokes and heart attacks. For Mr. Comiso, the traditional surgery would have been dangerous and likely impossible.

The Comisos then visited their neurologist who referred them to Dr. William Julien, a Board Certified Interventional Radiologist who practices full time endovascular surgery in Margate, FL.
“We were buying against time,” said Mrs. Comiso.


Dr. Julien enrolled Mr. Comiso into an FDA-approved carotid stent research trial for patients who are considered high risk for traditional carotid endartectomy surgery. The procedure offers a life-saving alternative for these patients and was sponsored by Boston Scientific Corporation. Only 780 people were enrolled, and Mr. Comiso was one of them. Since his left vocal cord was already paralyzed, his physicians determined that traditional surgery was too high a risk. Losing control of both sides of his vocal cords could have led to an emergency tracheotomy.

Carotid stenting is a minimally invasive procedure performed by inserting a catheter in the femoral artery passing it through the blood system and up into the carotid artery using X-ray guidance to navigate through the bloodstream. A novel filter device which looks like a tiny butterfly net is first inserted and positioned in the carotid artery downstream from the narrowing. The filter captures any particles that are inadvertently dislodged during the procedure while maintaing blood flow to the brain. An angioplasty balloon then expands the carotid narrowing followed by placement a tubular metal mesh called a stent. This stent acts as a scaffolding to hold the artery open. The final step is removing the filter along with any debris that was trapped during the procedure.

"I feel great. My voice is much better," said Mr. Comiso. "Dr. Julien was wonderful. This procedure not only saved my life but gave me my voice back. I am happy to share my story with others because it may save more lives. Patients and doctors need to know that this is available."

"Mr. Comiso was a delight to work with, and it was gratifying to use this new technology for his serious situation. Since the carotid stent procedure avoids any neck incisions, there is zero risk of vocal cord paralysis," said Dr. Julien. "My practice philosophy is to offer each patient the latest and best technologies, procedures, and medications currently available. Clearly, we were able to accomplish that here."

Dr. Julien emphasizes the importance of patient education and clear explanations on the details of a diagnosis, including short and long-term treatment plans, alternative treatment, and precisely what each patient should expect to experience. His practice has been highlighted as a model for the next generation of Interventional Radiology Practices.

The Guidant Corporation received the first FDA approval for a carotid stent platform on August 31, 2004 and Dr. Julien was the first South Florida physician to implant the newly approved device. The Boston Scientific device that Mr. Comiso had implanted as part of the research trial is expected to be FDA approved third quarter 2005. Dr. Julien's practice will serve as one of a few physician training sites. One of the innovative techniques used during the training will be the use of a sophisticated simulator that allows surgeons to practice on a dummy rather than a real patient.

“We think simulator training will become an important tool in training surgeons performing technically demanding and risky procedures such as carotid stenting,” said Dr. Julien.

For more information, visit www.southfloridavascular.com.

Arteriosclerosis

The Boynton Times

There is a light

I always talk about modern technology and the miracles performed daily. I recently received a story telling about a miracle and a light at the end of the tunnel.

This is a story about a medical breakthrough procedure called CryoPlasty, a frozen balloon angioplasty, which is benefiting many people with bad circulation and immobility.

The living proof of this story is about an 87-year old woman who is now living a normal life because of this procedure.

Jeanette Shorr was an extremely active 87-year old woman. One of her favorite activities as to walk the malls and shop as part of her daily routine. She walked for hours on end with a group of friends while they socialized; they also exercised at the same time.

Two months ago while engaging in her activity, Jeanette noticed she was unable to walk for any length without having to stop to catch her breath. She also experienced extreme pain in her left leg when this happened. After resting for a few minutes, she resumed walking. This was coming a very common occurrence and was getting worse. She noticed her quality of life was diminishing.

One day while engaging in her routine, her knee buckled and gave out completely. She knew that this was a problem needing medical advice immediately.

She asked around and was told there was a new procedure being done by Dr. William Julien, an Interventional Radiologist in Margate, Florida. He is the first physician in Broward County to perform the procedure. She sought him out and became his patient.

She was diagnosed with arteriosclerosis, namely a build-up of plaque in the arteries. With the new medical breakthrough, CryoPlasty, (a frozen balloon angioplasty,) her life was given back.

It is the only procedure to treat this type of problem. The build-up of plaque in the arteries is extremely treacherous, especially in the knee. Conventional angioplasty would not have worked in this part of the body.

The result of not using this procedure could have been the cause of a life threatening complication. Without it this lady would have to alter her lifestyle dramatically and would have been debilitated in movement and quality of life. She had to have the surgery.

Shortly after being operated, she returned to her busy, active lifestyle with her friends once more. She no longer had worries of falling or becoming incapacitated. She is very grateful to her doctor and for being about to live a much more complete life.

"Mr. Comiso was a delight to work with, and it was gratifying to use this new technology for his serious situation. Since the carotid stent procedure avoids any neck incisions, there is zero risk of vocal cord paralysis," said Dr. Julien. "My practice philosophy is to offer each patient the latest and best technologies, procedures, and medications currently available. Clearly, we were able to accomplish that here."

We never stop to think what our lives would be like if we were not able to be mobile. Jeanette was helped because of this breakthrough and procedure.

Her mind is now at ease and she is living a pain free, happy life enjoying what she likes doing best.

Stories like this are very enlightening and when I am sent something I feel can give my readers hope; I enjoy putting it in to the paper. Thank you for sharing your story with us and I hope it is an inspiration to others suffering from the same problem.

Modern medicine never stops finding new possibilities in so many areas thus creating a success story, as the one above.

A short while ago, I wrote on Hope, and the above is exactly what I was talking about. We must never feel that anything is so fatal that the result seems hopeless, you never know!

Uterine Fibroid Embolization

The South Florida Sun Sentinel

Non-invasive Treatment Helps New Mom In Trouble. Doctor Uses Rare Procedure to stop Bleeding, Save Uterus

Venus Tenerife couldn't wait to thank Dr. William Julien for her first Mother's Day with her husband and new baby. She almost didn't make it.

"I really didn't get a chance to talk to him the first time I saw him and thank him for all he did for me," said Tenerife, 34. "I definitely owe him a lot."

After 11 hours in labor on Easter Sunday, the Coconut Creek woman delivered a healthy 71/2-pound son, Justin Thomas, at Northwest Regional Medical Center in Margate.

But then she had complications -- life-threatening bleeding from her uterus.

"I was really scared when they told me what was happening," she said. "I could see all the commotion that was happening around me. I realized it could be serious and I could lose my uterus."

As time passed and the bleeding didn't stop, her obstetrician Dr. Tara Solomon was faced with two choices, begin a hysterectomy to remove the damaged uterus or call for a rare procedure that could stop the bleeding and save the uterus without Tenerife having to go through surgery.

The minimally invasive procedure, called uterine artery embolization, seals off the blood flow with a jellylike substance thinned to a slurry that's delivered into the bleeding artery inside the uterus by a tiny catheter. The substance eventually disappears.

Solomon called in Dr. Julien, an interventional radiologist, who alerted his team and rushed to the hospital. He has an endovascular surgery practice, the South Florida Vascular Associates, with offices adjacent to Northwest Medical Center.

"The procedure is rare. We probably only get one or two calls like this a year," Julien said. "When the call comes, you have to arrive with your game face on and ready to go. It's an emergency situation, like a fire drill, where the patient is in danger of dying.

"This is a case where you have got to get moving faster than almost any other situation. You are worried about the patient, the mother of a brand-new baby who potentially may not be around. It's pretty scary for a baby not having its mother."

By the time Julien arrived, Tenerife was in trouble.

"Her blood pressure had dropped, they were giving her transfusions, and they were thinking they might have to start the hysterectomy."

In a specially equipped operating room in the hospital, Julien used imaging equipment to steer the catheter through a tiny incision where the material was injected, and the bleeding was stopped.

For Tenerife, a physical therapist at Woodlake Nursing Rehabilitation Home in West Palm Beach, all Mother's Days from now on will be special.

"I feel very grateful. I am so lucky to have another chance to have a baby," Tenerife said. "I feel so great and thankful for everything they did to save me."

The next day, when Julien made his rounds and saw Tenerife and baby Justin, he said he was nervous until he saw for himself that the procedure was effective.

"It's always a scary period until you see the results. It's most gratifying to see a mom caressing her baby as she was, " he said."I can't express the words right now," Tenerife said, "but telling the doctor is really something that is easy and I have to do."

Dr. Julien Honored as a Top Physician in South Florida

South Florida Hospital News

Dr. William Julien is a board certified interventional radiologist with a full time endovascular practice. Dr. Julien places a strong emphasis on the importance of patient education offering his patients clear explanations on the details of a diagnosis, treatment plans, alternative treatment, and precisely what each patient should expect to experience. His practice is unique in that, unlike most interventional radiologists, Dr. Julien sees his own patients and treats many of them right in his office in a sophisticated endovascular surgery suite – one of the first of its kind in the country. His practice has been highlighted as a model for the next generation of Interventional Radiology Practices.

Currently, Dr. Julien is the President of South Florida Vascular Associates. He is also on staff at Northwest Medical Center. Some of Dr. Julien's past and present achievements are that he has been Director of Interventional Radiology at Florida United Radiology, as well as Chief of Interventional Radiology at a 3 hospital system here in South Florida. Dr. Julien has been principal investigator for several device trials for medical break-through procedures including carotid artery stenting. Because his skills are so specialized, Dr. Julien has frequently been asked to speak at national endovascular meetings and has also had the privilege of training many physicians on cutting-edge minimally invasive procedures. Dr. Julien is on the advisory boards of Boston Scientific and Medcomp.

He is a fellow of the Society of Cardiovascular and Interventional Radiology as well as Council for Cardiovascular Radiology at the American Heart Association.

Dr. Julien was one of the original researchers of Carotid Artery Stenting and was the first South Florida physician to implant the newly approved filter device upon its post-market approval.

Recently, Dr. Julien became the first doctor in South Florida to use a new FDA approved vessel closure system, StarClose™ This device closes the artery securely in a matter of seconds following diagnostic catheterization procedures such as those used to diagnose coronary artery disease. StarClose™ has the potential to change the current standard of vessel closure, which is manual compression. It is in the patient's and physician's best interest to close the femoral artery as securely, quickly and cleanly as possible to reduce complications, as well as allow patients to get up and walk around sooner.

Dr. Julien has also recently become one of the first doctors to implant a new wireless device during an endograft procedure for tracking aneurysm pressure called EndoSure™. This is the first time doctors can implant something in a patient that can send information without the use of batteries or a power source.
Because it is inside the body, the sensor gives doctors information they have never had before.

Minimally Invasive Procedures

By Gail M. Lassner - The Parklander

Painless new medical procedures make traditional surgery a thing of the past

A new and exciting trend in medicine offering minimally invasive surgical procedures has given local resident Franey Way the opportunity to ring in the New Year with a renewed sense of optimism.

It’s difficult to imagine her frustration when Way was told that she was considered too high-risk to undergo necessary surgery after being diagnosed with severe carotid artery stenosis. This disease is characterized as a build-up of plaque in the carotid artery which is the artery that supplies blood to the brain and when left untreated often results in a stroke.

Her frustration was soon replaced with an overwhelming sense of hope, as well as relief when she was introduced to Parkland resident Dr. William Julien, a Board-Certified Interventional Radiologist who practices full-time endovascular surgery in Margate. Dr. Julien told Way that she was a candidate for a new FDA approved minimally invasive life-saving procedure called Carotid Stenting. This procedure involves puncturing the femoral artery in the groin. Under x-ray guidance, a catheter device is then threaded through the blood stream into the carotid artery and then an angioplasty balloon and stent are inserted to hold the artery open.

Also employed is a novel technology involving the insertion of a filter device which stays in place during the procedure that catches particles which are often inadvertently dislodged during angioplasty, thereby minimizing the possibility of any complications which could occur during the surgery. Following her surgery, like so many others treated by Dr. Julien, Way is fully recovered after having undergone the hour long painless procedure. “Now I can enjoy my life,” she said gratefully.

Julien, on staff at Northwest Medical Center, was one of the original researchers of Carotid Stenting and was the first South Florida physician to implant the newly approved filter device. Presently, medicare coverage for this procedure is limited to patients like Way, who are considered too high-risk for traditional carotid endartectomy surgery. Dr. Julien sees this changing in the future. “I think ten years from now pretty much everyone will have carotid stenting procedures and very few people will have open surgery,” he said.

His practice is unique in that, unlike most interventional radiologists, Dr. Julien sees his own patients and treats many of them right in his office in a sophisticated endovascular surgery suite – one of the first of its kind in the country. He now performs minimally invasive varicose vein surgeries right in his office using local anesthesia. Traditionally, patients would have undergone surgery in the hospital under general anesthesia. The new procedure involves the use of an endoluminal laser guided by ultrasound which enters through the blood stream to close the abnormal vein. Patient's can immediately resume their non exertional activities.

Another new trend as we approach the New Year is a relief for the approximately 13 million American women who suffer from uterine fibroids. A new minimally invasive treatment option called Uterine Fibroid Embolization offers an alternative to having a hysterectomy. The procedure is performed with local anesthesia, again using interventional radiology catheter techniques rather than traditional surgery to destroy the blood supply to the fibroid tumors. As more women become aware of the availability of this procedure, Dr. Julien is confident that more will seek this new treatment option.

There are many benefits to minimally invasive endovascular surgery, according to Dr. Julien. Two-thirds of the surgeries are done right in his office, and procedures performed in the hospital are usually outpatient or sometimes a one night stay Also, because patients undergo local anesthesia, the surgeries are not painful and the risks associated with general anesthesia are eliminated. Additionally, these types of surgeries offer a significant savings to the health care system, especially since there is such a quick recovery time. Dr. Julien stresses that consumer awareness is critical. “Whoever performs endovascular surgery must be well trained and have a lot of experience,” he said. “Consumers should ask a lot of questions.” For more information visit www.southfloridavascular.com.

Carotid Artery Stenting

Boca Raton News

Local Resident Able to Enjoy Life After New Medical Procedure

Franey Way wasn’t able to garden and tend her flowers outside her Boca Raton home any more.
In fact, she wasn’t able to do much of any of the things she used to enjoy like cooking her favorite meals or making a trip to the local grocery store, after having a series of alarming episodes where her right hand and foot would become numb.

“I discovered it was very difficult to walk and at times I became uncoordinated,” said Way.

After urging from her daughter, the local resident went to the hospital to get checked out.
“I went to the Boca Raton Community Hospital. They admitted me right away, observed me and took tests. After a few days, they diagnosed me with severe carotid artery disease in my neck. It affects the blood supply to you brain, which is why I was having little episodes, which were actually tiny strokes called TIA’s. They told me surgery was too risky for me because of my medical history and that my blockage wasn’t severe enough to take that risk.

So, they sent me home with medication treatment,” said Way.
But the numbness and difficulty to walk started to become worse and more frequent for the 79-year-old resident.

“It was a feeling of clumsiness and lack of coordination. It was getting worse and more frequent,” said Way, who then decided to go to her family doctor, Matthew Pinto.

Since Way was at too-high risk for surgery Dr. Pinto referred her to Dr. William Julien, a Board Certified Interventional Radiologist who practices full-time endovascular surgery in Margate.

“The first time I walked into the examination room, I didn’t feel intimidated by him. He was like an old friend walking into the room,” said Way.

Julien checked out his new patient and thought she would be a perfect candidate for an FDA approved carotid stent research procedure since she was considered too-high risk for traditional carotid endartectomy surgery. The procedure offers a life-saving alternative for these types of patients, according to Julien.

Carotid Stenting is a minimally invasive procedure performed by inserting a catheter in the femoral artery passing it through the blood system and up into the carotid artery using X-ray guidance to navigate through the bloodstream. Then, a novel filter device which looks like a tiny butterfly net is first inserted and positioned in the carotid artery downstream from the narrowing. The filter captures any particles that are inadvertently dislodged during the procedure while maintaining blood flow to the brain.

Next, an angioplasty balloon expands the carotid narrowing followed by placement of a tubular metal mesh called a stent, which acts as a scaffolding to hold the artery open. The final step is removing the filter along with any debris that was trapped during the procedure.

“Franey’s a high risk patient, too-high risk for surgery and gets relegated to a category where no one wants to touch her. Her right carotid artery was closed off because of radiation damage because of that, blood flow to the brain was coming from the left artery and supplying both. The stroked would have been more devastating,” said Dr. Julien, an endovascular surgeon at North West Medical Center, who was involved in the national research trials for the procedure and was the first South Florida physician to implant the newly approved filter device.

Julien’s practice will serve as one of a few training sites, for other physicians who would like to learn how to administer the procedure where patients do not have to be put under anesthiea.

Way said the procedure was painless and took only about an hour and she has fully recovered. Way said now she can enjoy her life.

“Before I didn’t go shopping or I couldn’t have been gardening or out there watching my butterflies. Most of the time I was sure I was gong to fall,” said Way. “Now, all the symptoms are gone. I do my laundry. I do my cooking and I manage the house. I have no more episodes of numbness.”

Way said she encourages others diagnosed with same illness never to give up hope.

“Never give up. Keep looking for a solution and be open to change. Medicine is always changing. What we’ve done for years isn’t always what we should keep on doing,” said Way. For more Information, www.southfloridavascular.com.