Podcasts about carotid

CORE RESOURCES: Rutherford's Vascular and Endovascular Therapy 10th Edition, Chapters 88, 89, 91, and 94 Atlas of Vascular Surgery and Endovascular Therapy 2nd Edition, Chapter 9 ADDITIONAL RESOURCES: Audible Bleeding Episodes Holding Pressure - Carotid Endarterectomy: https://www.audiblebleeding.com/2024/02/27/holding-pressure-carotid-endarterectomy/ Holding Pressure Case Prep - Endovascular Basics: https://www.audiblebleeding.com/2023/04/23/holding-pressure-case-prep-endovascular-basics/ Videos TCAR Technical Video: https://jnis.bmj.com/content/14/8/842 Articles Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease:  https://www.jvascsurg.org/article/S0741-5214%2821%2900893-4/fulltext Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2931862-6 Referenced Studies ROADSTER-1 https://pubmed.ncbi.nlm.nih.gov/30611582/ ROADSTER-2 https://pubmed.ncbi.nlm.nih.gov/32811386/ https://pubmed.ncbi.nlm.nih.gov/35381327/ TCAR Surveillance Project https://jamanetwork.com/journals/jama/fullarticle/2757579?utm_source=openevidence&utm_medium=referral https://pubmed.ncbi.nlm.nih.gov/36172943/   OUTLINE:   CAROTID ARTERY DISEASE 1. Pathophysiology/etiology Carotid artery disease is primarily driven by atherosclerotic plaque deposition.  Risk factors: hypertension, hyperlipidemia, diabetes, smoking, and advanced age. Nonatherosclerotic etiologies: fibromuscular dysplasia, carotid dissection, vasculitic disease, carotid webs, and trauma. When the endothelium is damaged, monocytes migrate to the site and differentiate into macrophages that take up oxidized LDL particles to become foam cells. Meanwhile, an inflammatory response occurs where activated platelets release thromboxane A2, platelet derived growth factor, and inflammatory cytokines that promote further platelet aggregation and vascular inflammation. Smooth muscle cells migrate and proliferate, forming the structural framework of the atheroma.  Within the lesion, necrotic debris and lipid accumulate, creating a vulnerable plaque. Plaque rupture exposes this material to the bloodstream, serving as a nidus for thrombus formation which can lead to ischemic events. Carotid bifurcation is particularly prone to plaque formation due to turbulent blood flow. Embolization of plaque from this area can result in TIA or ischemic stroke.  2. Presentation Patients are often asymptomatic and stenosis is incidentally found on imaging.  Symptomatic patients present with neurologic symptoms including unilateral motor and sensory loss, aphasia (difficulty finding words), dysarthria (difficulty speaking), amaurosis fugax (temporary monocular vision loss due to embolus to the ophthalmic artery), transient ischemic attacks Physical exam findings may be notable for auscultation of a carotid bruit. Patients may also have evidence of retinal artery embolization on fundoscopic examination (Hollenhorst plaque) or asymptomatic cerebral infarction.  3. Diagnosis USPTF recommends against screening for asymptomatic carotid artery stenosis.  In patients with no risk factors, SVS recommends against screening for asymptomatic carotid artery stenosis. However, they do recommend screening for asymptomatic clinically significant carotid bifurcation in certain groups of patients with multiple risk factors.  These risk factors include patients with clinically significant peripheral vascular disease, patients 65 and older with history of CAD, smoking, hypercholesterolemia, and patients prior to coronary artery bypass.  Relevant findings on physical exam or imaging findings may warrant screening, but screening is not recommended for the presence of neck bruit alone without other risk factors, as this finding has a low sensitivity and specificity for detecting clinically significant carotid artery stenosis.  Carotid duplex ultrasound: first-line imaging modality for both screening and initial evaluation of stenosis, noninvasive, low-cost CTA: rapid, high-resolution, three-dimensional imaging of vascular anatomy, risk of contrast and radiation exposure MRA: high-quality, three-dimensional imaging without radiation or contrast, expensive with longer acquisition time, can overestimate stenosis in severe disease DSA/angiography: gold standard, expensive, invasive, not generally recommended for routine diagnostic evaluation or screening 4. Classification Carotid artery stenosis is classified by degree of luminal narrowing. NASCET method: standard in current practice. Compares the minimal residual lumen at the point of greatest stenosis to the diameter of the normal distal internal carotid artery.  Classification of stenosis: Mild: 70 bpm, and ACT >250 seconds to optimize cerebral perfusion and minimize thrombotic risk. Clamp the carotid artery just proximal to the arterial sheath to establish active flow reversal.  Flow controller settings: Low setting High setting Flow-stop button: allows for temporary cessation of flow (used when we inject contrast).  Confirm flow reversal via two different ways:  The first way is to stop flow to the venous return sheath with the stopcock, clearing the line with hep saline injection, and then opening the stopcock and seeing the blood returning to the controller in a reverse fashion. The second way is to perform an angiogram with a small amount of contrast injection while holding the flow-stop button. Using the angio we want to make sure that contrast is flowing retrograde in the cervical ICA thereby confirming flow reversal.    Carotid artery stenting, balloon angioplasty, and completion angiogram At this point, a standard carotid angioplasty and stenting procedure is performed. ENROUTE transcarotid Neuroprotection System device:  inner diameter of 8F and an outer diameter of 10F Has its own carotid artery stent system but is also compatible with all FDA-approved carotid stents.  Final angiogram is performed to confirm stent position, vessel patency, and absence of complications including vasospasm at the distal end of the stent and filling defects from protrusion of atheromatous material through the stent    Cessation of flow reversal and sheath removal Allow the flow reversal to run for a few minutes after the final balloon angioplasty to clear any debris.  Antegrade flow is restored by releasing the carotid clamp and closing the stopcocks on the neuroprotection system.  The patient is auto-transfused the blood from the flow line back to the venous system.  As the arterial access system is removed and the puncture site is closed with the U-stitch.  IV protamine is administered to reverse the heparin. Standard closure is performed at the incision site. Meanwhile, hemostasis is achieved after removal of the femoral vein sheath with brief manual compression.  Postop care/complications Postop care All patients after a TCAR should be monitored in the ICU setting for 24 hours, as an embolic stroke, hypotension with or without bradycardia, or hypertension can occur.  Should a TIA or stroke be observed, a carotid duplex scan and CT angiogram should be immediately obtained to assess the stent site and the presence of an embolic or thrombotic filling defect, dissection, or occlusion.  Dual antiplatelet therapy: continue for 45 days to 12 months Aspirin and statin therapy: continued indefinitely Surveillance duplex imaging: 4 weeks, 6 months, and 12 months, and annually thereafter. Postop complications Hematoma Stroke Myocardial infarction Cerebral hyperperfusion syndrome Sudden and excessive increase in cerebral blood flow to previously hypoperfused brain tissue is met with vasculature that cannot constrict appropriately from chronic vasodilation Leads to breakthrough hyperperfusion. This results in cerebral edema, intracerebral hemorrhage, and neurological symptoms.  Cranial nerve injury Hypoglossal nerve (CN XII) injury: ipsilateral tongue deviation. It is the most commonly injured cranial nerve.  Vagus nerve (CN X) injury: hoarseness and possible vocal cord paralysis.  Glossopharyngeal nerve (CN IX) injury: soft palate dysfunction.  Recurrent laryngeal nerve injury: voice hoarseness and inability to cough as it innervates all of the voice box muscles except for the cricothyroid muscle Marginal mandibular nerve injury: ipsilateral lip droop, injury is rare in TCAR.  Stent restenosis Pseudoaneurysm Access site infection

In this episode of the Neurocritical Care Society Podcast Masterclass series, hosts Stephan Mayer, MD, FCCM, FNCS, and Jon Rosenberg, MD, are joined by Seemant Chaturvedi, MD, professor of neurology and director of the Stroke Division at the University of Maryland, for an in-depth discussion on carotid disease, stroke prevention and the role of revascularization in clinical practice. The episode explores the historical impact of NASCET, key findings from the CREST-2 trial and the role of intensive medical management for patients with asymptomatic carotid stenosis. Dr. Chaturvedi also shares practical guidance for neurointensivists caring for patients with symptomatic carotid disease, including intervention timing, risk stratification and emerging diagnostic tools such as MRI plaque imaging and TCD microemboli monitoring. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

Welcome back to the Audible Bleeding series: Landmark Papers in Vascular Surgery. In this episode, co-hosts John and Dr. Jesse Columbo are joined by our guest, Dr. Caitlin Hicks, to discuss one of the most studied—and most debated—topics in vascular surgery: asymptomatic carotid stenosis.   In this episode, we'll trace that evolution through three pivotal trials: ACAS and ACST-1, which established carotid endarterectomy as the standard of care; and the newly published CREST-2, which challenges us to reconsider everything we thought we knew. Along the way, we'll explore how advances in statin therapy, blood pressure control, and antiplatelet agents have fundamentally changed the natural history of this disease—and what that means for our patients today."   Links to Landmark Papers:  (ACAS) Endarterectomy for Asymptomatic Carotid Artery Stenosis   (ACST-1) 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis: a multicentre randomised trial    (CREST-2) Medical Management and Revascularization for Asymptomatic Carotid Stenosis    Guests: Dr. Caitlin Hicks, MD (@CaitlinWHicks); Associate Fellowship Program Director, Vascular Surgery & Endovascular Therapy at Johns Hopkins and Director of Research   Hosts: John Culhane, MD (@JohnCulhaneMD); General Surgery Resident, Abrazo Health Dr. Jesse Columbo, MD; Assistant Professor of The Dartmouth Institute, Geisel School of Medicine, Dartmouth Follow us @audiblebleeding,   Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey. *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device. 

In this AJNR Article Summary, Dr. Francis Deng reviews CTA-based Carotid Plaque-RADS and its role beyond stenosis grading. He explains the key imaging features that define plaque vulnerability, then highlights two AJNR studies showing that the system is learnable, reproducible, and clinically meaningful for predicting future stroke risk, especially in patients with only mild or moderate carotid stenosis. Visit the website to read the related articles. Carotid Plaque-RADS: Inter- and Intrareader Agreement and Learning Curve Analysis in CTA CTA-Based Carotid Plaque-RADS Classification Improves Risk Stratification for Ischemic Cerebrovascular Events

Your arteries may be older than you are--here's how we find out. Credit available for this activity expires: 5/8/27 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/episode-3-carotid-ultrasound-seeing-vascular-age-2026a1000een?ecd=bdc_podcast_libsyn_mscpedu

For decades, a tight carotid stenosis felt like a ticking time bomb — a plaque waiting to throw an embolus and cause the next stroke. We were taught that severe narrowing meant surgery, and trials like ACAS and ACST-1 seemed to prove it. But medicine has changed. Statins, antiplatelets, tighter blood pressure control, even PCSK9 and GLP-1 therapies have quietly slashed stroke risk, and now newer data from CREST-2 suggest that for many asymptomatic patients, the knife — or the stent — may not add much at all. So if modern medical therapy works better than ever… who actually benefits from intervention anymore? Today, we unpack the evidence, the controversies, and how to counsel the patient who feels perfectly fine but has high-grade stenosis.Hosts: Carolyn Judge, Andrew Huang, Luciano Delbono, Frank Davis, Robert BeaulieuInstitution: University of Michigan, Department of Surgery, Section of Vascular SurgeryLearning objectives: Describe how modern intensive medical therapy has transformed the natural history of asymptomatic carotid stenosis and explain why contemporary patients experience substantially lower annual stroke risk than those in earlier eras. Interpret and compare the results of landmark trials—including ACAS, ACST-1, and CREST-2—to assess the relative benefits of medical therapy, endarterectomy, and stenting. Apply current evidence and guideline recommendations to patient care by selecting which asymptomatic patients are most likely to benefit from carotid revascularization versus optimized medical therapy alone. References:SVS Guidelines:Brook, R. D., et al. (2022). Society for Vascular Surgery clinical practice guidelines for management of extracranial carotid artery disease. Journal of Vascular Surgery, 75(1), e1–e67. https://doi.org/10.1016/j.jvs.2021.09.031CREST (1)Brott, T. G., Hobson, R. W., Howard, G., et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1), 11–23. https://doi.org/10.1056/NEJMoa0912321CREST-2Brott, T. G., Howard, G., Fong, P., et al. (2024). Randomized trial of carotid artery stenting or carotid endarterectomy vs best medical therapy for asymptomatic carotid stenosis: CREST-2 results. [Manuscript in preparation]. ClinicalTrials.gov Identifier: NCT02089217. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02089217ACST-1Halliday, A., Mansfield, A., Marro, J., et al. (2004). Randomised trial of carotid artery surgery for asymptomatic stenosis. Lancet, 363(9420), 1491–1502. https://doi.org/10.1016/S0140-6736(04)16153-1ACST-2Halliday, A., Bulbulia, R., Bonati, L. H., et al. (2021). Carotid artery stenting versus carotid endarterectomy in patients with asymptomatic carotid stenosis (ACST-2): A randomised trial. Lancet, 398(10291), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01980-1ACASExecutive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995). Endarterectomy for asymptomatic carotid stenosis. JAMA, 273(18), 1421–1428. https://doi.org/10.1001/jama.1995.03520420033036Sponsor URL: https://www.goremedical.com/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Clean lumen club! This week, BackTable meets you at the carotid bifurcation to discuss all things carotid angioplasty and stenting. Interventional neuroradiologist and cerebrovascular surgeon Dr. Adnan Siddiqui, Vice Chairman of the University of Buffalo's Department of Neurosurgery, joins host Dr. Sameh Sayfo to discuss the evolution and current state of carotid disease treatment. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Terumohttps://www.terumois.com/ --- Timestamps 00:00 - Introduction02:48 - From Aspirin to Endarterectomy03:47 - Rise of Carotid Stenting06:46 - CREST-2 and CMS Coverage09:57 - Management of Severe Asymptomatic Carotid Stenosis 15:35 - New Stent Designs Explained17:56 - Five Tips for New Operators20:08 - Case Selection Algorithm22:04 - Learning Curve and Mentorship28:27 - What's Next: IVL and Outpatient31:24 - Managing Complications Safely35:05 - Closing and Credits --- More about this episode Dr. Siddiqui details the history of carotid stenosis treatment, charting its path and progression from medical therapy to endarterectomy and modern stenting approaches. He includes how recent trial data and updated CMS reimbursements have influenced practice and generated recent developments such as second generation stent technology. Dr. Siddiqui shares perspectives on patient selection, operator learning curve, complication preparedness, and the importance of structured training and proctoring as technology and techniques continue to improve. The physicians close by overviewing future directions for the carotid space such as IVL and how to approach management of procedural complications. --- Resources Dr. Adnan Siddiqui provider profilehttps://www.ubns.com/physicians/dr-adnan-h-siddiqui/ Carotid Endarterectomy for Asymptomatic Carotid Stenosis: Asymptomatic Carotid Surgery Trial (ACAS)https://www.ahajournals.org/doi/10.1161/01.str.0000141706.50170.a7 Asymptomatic Carotid Surgery Trial (ACST-2)https://www.acc.org/latest-in-cardiology/clinical-trials/2021/08/25/23/24/acst2 Protected Carotid-Artery Stenting versus Endarterectomy in High-Risk Patients (SAPPHIRE trial)https://www.nejm.org/doi/full/10.1056/NEJMoa040127 Medical Management and Revascularization for Asymptomatic Carotid Stenosis (CREST-2 trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2508800 The North American Symptomatic Carotid Endarterectomy Trial (NASCET trial)https://www.ahajournals.org/doi/10.1161/01.str.30.9.1751

In this episode, host Rick Greene, MD, FACS, talks with Brajesh Lal, MBBS, FACS, professor of vascular surgery at the University of Maryland School of Medicine and chief of vascular service at the Baltimore Veterans Affairs Medical Center. Dr. Lal and colleagues recently published research on Medical Management and Revascularization for Asymptomatic Carotid Stenosis in The New England Journal of Medicine, finding that adding stenting to medical management for carotid stenosis helps reduce the risk of stroke or death within 4 years; however, Dr. Lal tells Dr. Greene it's too soon to discount the benefits of carotid endarterectomy.   Talk about the podcast on social media using the hashtag #SurgicalReadings

Emotional Anger After Stroke: Trisha Winski’s Story of a Carotid Web, Aphasia, and Learning to Slow Down Trisha Winski was 46 years old, working as a corporate finance director, with no high blood pressure, no diabetes, and no smoking history. By every conventional measure, she was not a stroke candidate. Then one morning, she stood up from the bathroom, collapsed, and couldn’t speak. Her ex-husband, sleeping on her couch by chance the night before, found her and called 911. The cause was a carotid web, a rare congenital condition she never knew she had. Three years and three months later, she’s living with aphasia, rebuilding her sense of self, and navigating something that doesn’t get nearly enough airtime in stroke conversations: emotional anger after stroke. What Is a Carotid Web — and Why Does It Matter? A carotid web is a rare shelf-like membrane in the internal carotid artery that disrupts blood flow, causing stagnation and clot formation. It is a form of intimal fibromuscular dysplasia and affects approximately 1.2% of the population. Most people never know they have it. Unlike the more commonly cited stroke risk factors, such as hypertension, diabetes, smoking, and obesity, a carotid web is congenital. You are born with it. There is no lifestyle adjustment that would have prevented Trisha’s stroke. That distinction matters enormously when you are trying to make sense of what happened to you. “I have nothing that could cause it,” Trisha says. “No blood pressure, no diabetes. It’s hard.” The treating hospital, MGH in Boston, caught the carotid web, something Trisha was later told many hospitals would have missed. It is a reminder of how much diagnosis still depends on the right clinician, the right technology, and a degree of luck.   Why Am I So Angry After My Stroke? One of the most underexplored dimensions of stroke recovery is emotional anger, not just grief, not just fear, but a specific kind of rage that has no clean target. “Why me? Why did I have to have it? It’s frustrating. It’s so frustrating,” Trisha says. “I’m just mad. I don’t know who I’m mad at.” This is a clinically recognized phenomenon. Emotional dysregulation after stroke can have both neurological and psychological origins. The brain regions that govern emotional control may be directly affected by the injury. At the same time, the psychological weight of sudden, unearned loss of function, of identity, of a future you thought you understood is enough to generate profound anger in anyone. For people like Trisha, who had no risk factors and no warning, the anger is compounded. There is no behaviour to regret, no choice to unwind. The stroke simply happened. That can make the anger feel even more directionless and, paradoxically, even more consuming. “Why me? Why did I have to have it? It’s frustrating. It’s so frustrating.” Bill’s gentle reframe in the conversation is worth noting here: “Why not me? Who are you to go through life completely unscathed?” It’s not a dismissal, it’s an invitation to move from the question that has no answer to the one that might.   Aphasia: The Deficit That Hurts the Most Trisha’s stroke affected her left hemisphere, producing aphasia, a language processing difficulty that affects word retrieval, word substitution, and speaking speed. Her numbers remained largely intact, which helped her return to her finance role. But the aphasia has been, in her own words, the hardest part. “If I didn’t have that, I wouldn’t be normal, but I could be normal,” she says. “The aphasia kills me.” One of the quieter consequences of aphasia that Trisha describes is self-censoring, stopping herself from communicating in public because she fears taking too long, disrupting the flow of conversation, or being misunderstood. She has developed a workaround: telling people upfront she has had a stroke, so they give her the time she needs to get her words out. The frustration-aphasia loop is well documented: the more stressed or frustrated a person becomes, the worse the aphasia tends to get. The therapeutic implication is significant. Managing emotional anger after a stroke is not just a well-being issue for someone with aphasia; it is directly tied to their ability to communicate. “Whenever I’m not stressed, I can get it out. When I get nervous, I can’t,” Trisha explains.   The Trauma Ripple: It’s Not Just About You One of the most striking moments in this episode is when Trisha reflects on her son Zach and ex-husband Jason, both of whom were visibly distraught in the days after her stroke. “I had a stroke. Why are they traumatized?” she says and then catches herself. “I forgot to look at it from their perspective. They watched me have a stroke.” This is something stroke survivors frequently underestimate. The people around them, partners, children, friends, even ex-partners like Jason, carry their own version of the trauma. They watched helplessly. They made decisions under panic. They grieved a version of the person they knew, even as that person survived. Acknowledging this doesn’t diminish the stroke survivor’s experience. It widens the frame of recovery to include the whole system and opens the door to conversations about collective healing.   Neuroplasticity Is Real — Give It Time Three years and three months after her stroke, Trisha’s message to people in the early stages of recovery is grounded and honest. “Neuroplasticity really does exist. My brain finds places to find the words I never had before. It takes longer, but it gets there. Just give yourself time.” She also reflects candidly on going back to work too early, returning before she was medically cleared, crying every day, and unable to follow her own cognitive processes. “I should have waited,” she says. “But I did it. It taught me that if I ever had it again, I won’t do that.” Recovery after stroke is non-linear, unglamorous, and deeply personal. But the brain is adapting, always. Trisha’s story is evidence of that and a reminder that emotional anger after a stroke, however consuming it feels, is not the end of the story.   Read Bill’s book on stroke recovery: recoveryafterstroke.com/book | Support the show: patreon.com/recoveryafterstroke  DisclaimerThis blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. Why Me? Navigating Emotional Anger After Stroke When You Did Nothing Wrong No risk factors. No warning. Just a carotid web she never knew about — and three years of emotional anger, aphasia, and finding her way back. Tiktok Instagram Facebook Highlights: 00:00 Introduction – Emotional anger after stroke 01:36 The Day of the Stroke 07:05 Post-Stroke Challenges and Rehabilitation 13:06 Ongoing Health Concerns and Medical Appointments 22:40 Navigating Health Challenges and Medical Support 30:20 Acceptance and Coping with Mortality 38:36 Communication Challenges and Aphasia 42:09 The Journey of Recovery and Self-Discovery 51:51 Facing the Aftermath of Stroke 59:22 Emotional Impact on Loved Ones 01:04:57 Navigating Life Changes 01:13:25 Finding Joy in New Passions 01:25:12 Trisha’s Journey: Emotional Anger After Stroke Transcript: Introduction – Emotional anger after stroke Trisha Lyn Winski (00:00) I don’t have anything that could cause it. I have nothing that, no blood pressure, no diabetes, It’s hard. It’s hard. don’t… It makes me mad. Really mad. Really, really mad that I to stroke. And like, everyone that has it… Bill Gasiamis (00:07) Yeah. Trisha Lyn Winski (00:21) or every dozen. I’m like, why me? Why did I have to have it? It’s frustrating. It’s so frustrating. Bill Gasiamis (00:28) Yeah, mad at who? Trisha Lyn Winski (00:30) I don’t know. I’m just mad. Like, I don’t know who I’m mad at. Bill Gasiamis (00:35) Before we get into Trisha’s story, and this is a raw, honest, and really important one, I wanna share a tool I’ve been using that I think can genuinely help stroke survivors get better answers faster. It’s called Turn2.ai. It’s an AI health sidekick that helps you deep dive into any burning question you have about your recovery. It searches across over 500,000 sources related to stroke, new research, expert discussions, patient stories and resources, and then keeps you updated on what matters each week. I use it myself and it’s my favorite tool of 2026 for staying current with what’s happening in stroke recovery. It’s low cost and completely patient first. Try it free and when you’re ready to subscribe, use my code, Bill10 at slash sidekick slash stroke to get a discount. I earn a small commission if you use that link at no extra cost to you. And that helps keep this podcast going. Also my book, The Unexpected Way That a Stroke Became the Best Thing That Happened is available at recoveryafterstroke.com/book. And if you’d like to support the show on Patreon and my goal of reaching a thousand episodes, you can do that by going to patreon.com/recoveryafterstroke. Links are in the show notes. Right, Trisha Winsky was 46 years old, healthy, had no risk factors and then a carotid web. She never knew she had changed everything. Let’s get into it. Bill Gasiamis (02:06) Trisha Winski, welcome to the podcast. Trisha Lyn Winski (02:09) Thank you. Bill Gasiamis (02:10) Also thank you for joining me so late. I really appreciate people hanging around till the late hours of the evening to join me on the podcast. I know it’s difficult for us to make the hours that suit us both. I’m in the daytime here in Australia and you’re in the nighttime there. Trisha Lyn Winski (02:27) Yeah. Yeah. It’s okay. I can come to you later. Yeah, it’s late. Bill Gasiamis (02:34) As a stroke survivor, is it too late? Trisha Lyn Winski (02:36) No, no, not at all. Bill Gasiamis (02:38) Okay, cool. Tell me a little bit about what you used to get up to. What was life like before the stroke? Trisha Lyn Winski (02:45) I just get up and get to work. deal with it all day, come home, I’d go to the restaurant, the bars, my friends, and then like I had a stroke and everything changed. Everything changed in an instant. Bill Gasiamis (03:00) How old were you in the district? Trisha Lyn Winski (03:02) I was 46. Bill Gasiamis (03:04) And before that, were you in a family, married, do you have kids, any of that stuff? Trisha Lyn Winski (03:08) I have a kid. Now he’s 28. He was 25 when I had it. I was married before, but like a long time ago. Actually, my ex found me when I had a serve. So he’s the one who found me. But so yeah, that’s all I have here. My mom passed away in November. So it’s been challenging. Yeah. Bill Gasiamis (03:30) Dramatic, ⁓ Sorry to hear that. how many years ago was a stroke? Trisha Lyn Winski (03:37) ⁓ It’s three years and three months. Bill Gasiamis (03:41) Yeah. What were you focused on back then? What were the main goals in your life? Was it just working hard? Was it getting to a certain time in your career? What was the main goal? Trisha Lyn Winski (03:50) I think I working hard, but I just wanted to get to a good place in my career. And I think I was in a good place. Now I second guess at all time because I’ve had strokes now, it doesn’t matter what happens. I’m always second guessing it. But I was in a good place. I just felt like I needed to make them better. And the stroke happened and I so didn’t. Bill Gasiamis (04:17) What kind of work did you do? Trisha Lyn Winski (04:18) I was the corporate finance director for an auto group. Bill Gasiamis (04:22) A lot of hours was it like crazy hours or was just regular hours. Trisha Lyn Winski (04:26) No, I worked a lot of hours, but in the end he wanted me work like 40, 50 hours a week. I couldn’t do that. 50 hours a week was killing me, but 40 was enough. Yeah. Bill Gasiamis (04:37) Yeah. Were, did you consider yourself healthy? Was there any signs that you were unwell, that there was a stroke kind of on the horizon? Trisha Lyn Winski (04:46) No, nothing, The day before this, had, my eye was like, I want to say it’s twitching, but it wasn’t twitching. It was doing something like odd. And I didn’t realize that until I had a TIA recently, but I realized it then. It’s, how can I explain it? It’s like a clear, a blonde shape in my eye. it, when I move, it goes with me. And I try to see around it, I can’t see around it. And I said to Gary, I worked with him, was like, I’m gonna have to go to hospital. This continues. can’t see.” And then it went away. And that’s the only symptom I had. Only symptom. And he said, no, I should told you that you might be having a stroke. like, even if you told me that, I never believed him. Never. Bill Gasiamis (05:23) Hello? Yeah. When you’re, and it went away and you didn’t have a chance to go see anyone about it. Trisha Lyn Winski (05:37) Yeah, it went away in like, honestly, like five minutes. So I didn’t see anybody, but I thought it was okay. I mean, I guess now that I’m looking back at it, it’s kind of odd. It’s one eye, but I felt like it was gone. I don’t know. yeah. No, you don’t. Bill Gasiamis (05:55) Yeah. How could you know? mean, no one knows these things. And, and then on the day of the stroke, what happened? Was there any kind of lead up? Did you notice not feeling well during that day? And then the stroke, what was it like? Trisha Lyn Winski (06:09) No, so I get up like every other day to go to work. I went in the bathroom and the night before that Jason said Jason’s ex-ad he stayed at my house because he needed need a place to stay because he couldn’t go out Zach again. I was like okay we’ll sleep in my couch I’m gonna go to work tomorrow but you can sleep here. So he was there and I think if he wasn’t there I would have died. Post-Stroke Challenges and Rehabilitation Makes me sad. Um, anyway, so when I woke up I went to bathroom and I stood up from the toilet and I like I fell over and I I didn’t even realize it. So I fresh my face in like five places when I fell and I didn’t even I didn’t even know it my whole side was numb. So I didn’t feel it. And Jason, you know, helped me to bed. I thought he helped me to bed. He didn’t he like drug me to bed. He got in the bed and then I… He came back in like five minutes later, are you okay? Like he knew something was wrong. And I couldn’t articulate to him. So I said, I’m fine, I’m fine. I’m gonna go to work. So he put the phone in my hand to call my boss. And he came back in like five minutes later and I… He put it in my right hand so I didn’t call anybody. And he said, my God, I’ll never forget this. He said, my God, you’re having a stroke. And I couldn’t talk. I couldn’t talk. I just… Yeah, I could hear him say that, but I couldn’t talk to him. It’s… It’s really scary. Like, even talking right now, like… It upsets me. Bill Gasiamis (07:37) but you can hear him say that. This is really raw for you, isn’t it? Yeah, understand. went through very similar things like trying to speak about it and getting it out of my self and trying to, you know, bring it into the world and get it off my shoulders. Like often brought me to tears and made it really difficult for me to have a meaningful conversation with anyone about it. Trisha Lyn Winski (08:07) It does. Bill Gasiamis (08:09) There’s small blessings there with you, okay? All happened when for whatever reason your ex was in the house and was able to attend you. It’s an amazing thing that that is even possible ⁓ considering how some breakups go and how possible. Yeah. Yeah. And so he called 911 and got you to hospital. Is that how you ended up in hospital? Trisha Lyn Winski (08:15) I know. We’re good friends, it was a challenge. Yes. So they ended up taking me to MGH, it’s a hospital right down the street from me. ⁓ But he’s not from here, he’s from Pennsylvania. he didn’t know where to me, like, just has to go to the hospital. So they knew when they came up. So MGH is like known for their strokes, they’re like really good at strokes. ⁓ And so that’s where they plan on taking me. Bill Gasiamis (09:01) Yeah. And do you get a sense of what happened when you were in the hospital? Do you have any kind of recollection of what was going on? Trisha Lyn Winski (09:11) I honestly, in the first week, no. I remember seeing, in the first day, I saw Zach, my son, and Zach, his brother Connor was in there too, and Jason, they all were there with me when I woke up. But I saw them, and I saw my friend Matt, and then that’s all I remember seeing. I remember seeing my mom on the third day. I’m in jail on this third day, but that’s about it. Bill Gasiamis (09:41) Yeah. And then did you have deficits? couldn’t feel one of your sides? Did that come back, whole problem, that whole challenge? Trisha Lyn Winski (09:50) So the right side, it came back, but it came back like sporadically. So I just kind of want to come back. So the first day I saw Matt and I put up my arm to talk to him and I couldn’t like put my arm out. So I just like tap my arm. ⁓ Now I can move my arm fully, but I can’t, I don’t have the dexterity in my arm. So I can’t like. I can’t flip an egg with this hand. it’s like this and then this is like that. I can’t do this. ⁓ And my right foot has spasticity in it. then the three toes on the side, I could curl them up all the time. Bill Gasiamis (10:36) Okay, next. Trisha Lyn Winski (10:37) and I did botox for it, nothing helps. Bill Gasiamis (10:40) huh. Okay. Have you heard of cryo-neuralysis? Trisha Lyn Winski (10:42) yeah, yeah, I got that back. Bill Gasiamis (10:45) You got cryo-neuralysis? Trisha Lyn Winski (10:47) No, what are you saying? Bill Gasiamis (10:49) That’s spasticity treatment. Cryo-neurolosis, it’s a real weird long word. There’s a dude in Canada that ⁓ started a procedure to help freeze a nerve and it expands the ⁓ tendons or something around that and it decreases spasticity and it lasts longer than Botox. Trisha Lyn Winski (10:50) ⁓ no. Okay. ⁓ yeah, you need to give me his name. We’re gonna talk. That’s I went twice to have it done. ⁓ it didn’t help at all. And I met, I met the guy, ⁓ the diarist, diarist ⁓ at the hospital. And he said, I didn’t think it was, it was going to work. I’m like, it’s the first I saw you. And he was like, I saw you and you had the shirt. I’m like, okay. I saw a million people that we can’t, I don’t remember who they are. Bill Gasiamis (11:20) Okay. Yeah. All right. So I’m going to put a link to the details for cryo-neuralysis in the show notes. ⁓ you and I will communicate after the podcast episode is done. And I’ll send you the details because there’s this amazing new procedure that people are raving about that seems to provide more relief than Botox in a lot of cases, and it lasts longer. And it’s basically done by freezing the nerve or doing something like that to the nerve. in an injection kind of format and then it releases the spasticity makes it improve. ⁓ well worth you looking into it, especially if you’re in the United States and it’s in Canada. ⁓ I know that doctor is training people in the United States and around the world. So there might be some people closer to you than Canada that you can go and chat about. Yeah. And how long did you spend in hospital in the end? Trisha Lyn Winski (12:28) Yeah. Yeah. Awesome. I love it. four weeks. Yeah. So the first, the first week I was at MGH, ⁓ they kept me for longer in the ICU because I had hemorrhagic conversion, transformation, whatever it’s called. I, you know what that is? Well, that went from the, I can’t think of what I was trying to say. Bill Gasiamis (12:40) for weeks. Ongoing Health Concerns and Medical Appointments Trisha Lyn Winski (13:05) It went from the aneurysm to the, not the aneurysm, the. Bill Gasiamis (13:09) The carotid artery. The clot, ⁓ Trisha Lyn Winski (13:11) ⁓ yes. Yeah, carotid artery and went to my brain. So I my brain bleed for a couple of days, but not like bleed, bleed, but it showed blood. So they kept me in it for longer. Bill Gasiamis (13:23) Okay. And then did you go straight home? Did you go to rehab? What was that like? Trisha Lyn Winski (13:29) I went to rehab for three weeks. And I sobbed my eyes out. So at that point I was like, I was good, but I wasn’t at all good, but I thought I was good. I said, I wanna go home, I wanna go home. My son can, he teach me all, do all this stuff, I gotta go home. Now that I’m past it, there’s no way he could tell me, no way. I couldn’t tie my shoes. Bill Gasiamis (13:34) three weeks. And when you came home, were people living with you? Trisha Lyn Winski (13:56) So he’s. No, nobody was living with but he had to come move in with me for three months. Bill Gasiamis (14:06) Yeah, your son, yeah. What was that like? Trisha Lyn Winski (14:07) Yeah. Here’s my proxid. I mean, honestly, at the time it was fine because I slept all the time. I slept like, God, I would go to bed like seven, 730 at night. And I was sleeping until like, at least, some sort of next day. I’d get up for a few hours, do what I had to do, and then fall back asleep. But just, I slept for a lot. So it was okay then. But come to the end of it, I’m like, okay, it’s time for you at your place. I need my space again, but yeah, he’s yeah, I need to have my own space. But at the time I know I need to rest. Yeah, I do. Yeah. ⁓ Bill Gasiamis (14:36) Yeah. and you need somebody around anyway. It’s important to have something near you if you’re unwell. Do they know what caused the stroke? Trisha Lyn Winski (14:53) ⁓ So I had a karate web. means that… ⁓ It’s really, it’s really rare. Only like 1.2 % of the whole population has it and I had it. It’s co-indentinob… co-ind… it’s… so I got it I was born. Bill Gasiamis (15:11) Yep, congenital. Trisha Lyn Winski (15:13) congenital, but they don’t know. I said that that would make it so much sense that they did a scan of your whole body at some point. I would have known that I had that years ago, but I didn’t know it. Bill Gasiamis (15:26) I don’t know what to look like, what to look for. The thing about scans, the whole body, my good friend of mine, the guy who helped me out when I was in hospital, he’s a radiographer and he does MRIs and all that kind of stuff. And he used to do my MRIs happened to be my friend happened to be working at the hospital that I was at. And he used to come and see me all the time. And I said to him, can we do a scan, you know, a preventative scan and check out, you know, my whole body? And he said, well, we can, but Trisha Lyn Winski (15:28) I know. Yeah. Bill Gasiamis (15:53) What are we looking for? I said, I don’t know anything. He said, well, we could, we could find a heap of things or we could find nothing. And if we don’t know what we’re looking for, we can’t set our scanners to the particular, settings to find the thing that you’re looking for. Because one scanner looks for hundreds of different things and the settings for to look for that thing has to be set into the scanner. And that’s only when people have a suspicion that you might have X thing. Trisha Lyn Winski (16:09) Yeah. Bill Gasiamis (16:23) then they set the scanner to find X thing and then they’ll look for it then they find it. He said, well, if we go in and do whole body scan, but we don’t even know what resolution to set it, how long to do the scan for. We don’t know what we’re looking for. So we don’t know what to do. And you have to be able to guide me and say, I want you to look for, in my case, a congenital arteriovenous malformation. In your case, carotid web. And in anyone else’s case is an aneurysm or whatever, but a general scan. Trisha Lyn Winski (16:38) Yeah. Bill Gasiamis (16:53) Like it’s such a hard thing to do for people. then, and then sometimes you said you find things that people do have unexpectedly because they go in for a different scan and then you discover something else. But now they’ve got more information about something that’s quite unquote wrong with them. And it’s like, what do you do with that information? Do I do a procedure to get rid of it? Do I, do I leave it there? Do I monitor it? Like, do I worry about it? Do I not worry about it? Trisha Lyn Winski (16:56) Yeah. Bill Gasiamis (17:21) is that it throws a big kind of curve ball out there and then no one knows how to react to it, how to respond. So it’s a big deal for somebody to say, can we have a whole body scan so we can work out what are all the things wrong with me? Trisha Lyn Winski (17:38) I it’s true, but I think that for me, most people have a carotid web. It’s obvious. know how old you are, it’s obvious. So then in that regard, like a carotid web, it looks a little indentured in the bloodstream. looks a little indentured in your artery. So I think that they would have seen it, but… ⁓ Bill Gasiamis (18:02) I love her. Trisha Lyn Winski (18:06) But then again, I don’t know. The hospital I went to, he said, you’re lucky you came here because most hospitals would have missed us. and I’m like, Bill Gasiamis (18:15) because they probably didn’t have the technology to find it. Trisha Lyn Winski (18:17) I don’t know. when I came to, it wasn’t months later, but I saw it on the scan. like, ⁓ it’s right there. ⁓ He said, yeah, but I thought it would be obvious, but it’s not so obvious. Bill Gasiamis (18:33) I just did a Google search for it and it says a carotid web is a rare shelf like membrane type narrowing in the internal carotid artery, specifically arising from the posterior wall of the carotid bulb. It is a form of intimal fibromuscular dysplasia that causes blood to stagnate forming clots that can lead to recurrent often severe ischemic strokes. Okay. So it causes blood to stay stagnant in that particular location causing clots. And you in the time we’ve been communicating, which is only in the last three or four weeks, you even sent me a message saying you just had an S you just had a TIA. ⁓ how come you’re still having clots? they not treating you or Trisha Lyn Winski (19:20) Yeah. No, I think they so they gave me um a scent in my re to kind of write that I don’t know why I had it cuz um, but my eye was like acting crazy again Just one eye and I I didn’t want to go to the hospital. I I don’t want the hospital at all for anything if I have if I don’t have to go I’m not going to hospital I Text Jason and Zach and they’re like no you have to go like I’ll wait a little while so Meanwhile, I was waiting a little while because I didn’t want to go and then I listened to ⁓ a red chat chat GBT He said no you have to go right now. Here’s why I’m like Now it’s like five hours later. I’m Sorry, so I went but and they said that I have ⁓ It’s likely I had a clot They don’t know where it came from though. So that’s that’s the thing is it’s confusing and by the way I think there’s something to be said about ⁓ I think if you have a stroke You can have one again easier than somebody who didn’t. I didn’t know that, but I learned it quickly. ⁓ So they said I had it, maybe went up in my eye, but it broke apart before it became an actual stroke. But I don’t know. Bill Gasiamis (20:41) thing. I love that you didn’t want to go and you ignored the male influences in your life, but you listen to chat. Trisha Lyn Winski (20:50) Thank you. I did, I did. They’re so smart. they say, I find on Google anyway. So that I listened to ChatGVT, it was like, I don’t know. And I know that like… Bill Gasiamis (21:05) You know that that’s kind of mental. Trisha Lyn Winski (21:08) It is actually, but I know that like my son is actually really smart and I think that they, but I didn’t listen him. I just listened to Chad Judy. Bill Gasiamis (21:18) Yeah. Anyhow, I love that you went in the end because, ⁓ and why don’t you want to go like, you just hate doctors and hospitals and that kind of thing? They saved you, didn’t they? Didn’t they save you? Didn’t they help you? Trisha Lyn Winski (21:29) There was? Yeah, but I don’t know. I think I spent so much time in there. ⁓ I don’t know. It’s in my head. I don’t like to sit in hospitals because of that. So after having the stroke, I stayed in hospital for month. I got out. I went back in like two weeks. I fell over twice. They thought that’s why. So when I was in hospital, something like they go Vegas something is pretty common. And I was like, okay, I did want to go then. I did want to go and then Zach made me. And then two months later, I went in to get the stint. And at that time I got a period. So it’s a long story. But I said to the doctor, I’m like, well, I’ll be okay. Does it do anything else because of this? He’s like, no, you should be fine. But if it gets bad, you have to go the hospital. he got bad. I almost died. I almost died from that. And that made me traumatized because I was awake and alive for all of it. I saw it all and passed out like six times in like three, I don’t know how many days, like five days. Yeah, but. Navigating Health Challenges and Medical Support Bill Gasiamis (22:46) Yeah. The challenge with something going wrong in hospital is that it’s less likely to be as dramatic as something going wrong at home. And that’s the thing, right? If you haven’t got help, then the chances that your stroke cause you way more deficits. That’s like so much worse. The best place for you to be is somewhere other than at home because you don’t want to risk being at home alone when something goes wrong and then you’re home alone. Trisha Lyn Winski (23:04) Yeah. Bill Gasiamis (23:15) when the blood flow has stopped to your head for a lot of hours. Like it could kill you, it make you more disabled and it could do all sorts of things. it’s like, but I get the whole, what is it like? It’s kind of like an anxiety about medical people and hospitals and stuff like that. Trisha Lyn Winski (23:20) Yeah. Yeah. I think that it’s mostly like I don’t like to stay there. I got a weird thing about this. I don’t like to stay there. I can stay anywhere I go, but the hospital really bothered me. I think that they were actually pretty good to me. So I’m not mad at them for that. ⁓ But I don’t want to see them now if I can possibly help it. Bill Gasiamis (23:54) Yeah, you’re done with them. Trisha Lyn Winski (23:56) I’m totally done. Bill Gasiamis (23:58) Yeah, I get it. I got, I got to that stage. My dramas were like three or four years worth of, you know, medical appointments, scans, surgery, rehab. Trisha Lyn Winski (24:07) Oh my god. Medical appointments. Medical appointments, forget it. They’re like, oh my god. I have so many of them, I can’t even say it. Bill Gasiamis (24:11) Yeah. I hear you. hear you. went through the same thing and then I got over it. now lately I’ve been going back to the hospital and seeing medical doctors for, um, not how I haven’t got heart issues, my, I’ve got high blood pressure and they don’t know what’s causing it. And, know, I’ve had my heart checked. I’ve had my arteries checked. I’ve had all these tests, blood tests, MRIs, the whole lot, and it’s getting a little bit old, you know, like I’m over it. But the truth is without them, I don’t. I don’t have a hope. Like if my blood pressure goes through the roof, you know, which had been, had been sitting at 170 over 120, 130. And I have a brain hemorrhage because of uh, high blood pressure. know what a brain hemorrhage is like, you know, I don’t want to have another one. So I’m like, I am going to, uh, I’m going to shut up, go through it and be grateful that I have medical support. Um, which, which Trisha Lyn Winski (24:55) Yeah. I know. Yeah. Bill Gasiamis (25:14) You know, a lot of people don’t get to have, it’s like, whatever, you know, I’ll cop it. I’ll cop it. I’ll go. And hopefully they can get ahead of it. So now they’re just changing my medication. I want to get to the bottom of it. Why have I got high blood pressure? The challenge with the medical system that I have is, is they just tell you, you have it and here’s something to stop it from being high. But I, they never say to you, we’re going to investigate why, like we’re going to try to get to the bottom of it. Trisha Lyn Winski (25:16) Yeah. Yeah. Bill Gasiamis (25:40) and I’ve been pushing them to investigate why do I have high blood pressure. Trisha Lyn Winski (25:44) sure. So I don’t have, I never had high blood pressure but speaking of I’ve, I don’t have a problem with my heart but they, so that when I had this for the first time they made me get out and have to, I had to wear a heart monitor for a month and I said like why am I wearing a heart monitor? There was something, they, I don’t know what it is. Bill Gasiamis (25:51) Yeah. Trisha Lyn Winski (26:13) Afib or something like that in there. And this time was the same thing. had heart bars over there right now. I had to send it back and they’re gonna send me new one. every time I’ve taken my heart test, and by the went for EKG just the other day. It was fine. But they found like something near my heart rate, it’s not like I need to be concerned about these. It’s nothing I need to be concerned about. So I was like, okay. They’re making you wear that for a month. Anyway. Bill Gasiamis (26:46) Yeah, just to go through things, just to check things, just to work some stuff out. Trisha Lyn Winski (26:47) Yeah. Yeah, yeah, this month I have ton, I have like seven appointments. Bill Gasiamis (26:56) Yeah, I used to forget my appointments all the time, even though I had him in my calendar, even though I had reminders, I just, even though I got reminded on the day, an hour before, two hours before, he meant nothing to me. I would just completely forget about him. Trisha Lyn Winski (26:59) me too. Me too. Same thing. I forgot all of it. And I had to share it with Zach and he could tell me, have an appointment. Like, okay. I forgot. He’s like, have an appointment. I’m like, fuck, I have to go. Bill Gasiamis (27:13) Yeah. How long did it take you to get back to work? Trisha Lyn Winski (27:28) I at least I went back to work. I went back to work before I was told I could go back to work. And I wrote them an email like, listen, I can’t sit at home and run one fucking freeze. I need to do something. So I went back to work. ⁓ And at first I went back to work part time. And honestly, like I cried. I left there crying every day. And not because I think that I. Not because of people. don’t think it was the people. I couldn’t understand. My head was like… I couldn’t focus and put all that work into my… I couldn’t put it into me. So I couldn’t understand what I was doing. And then you give them a month. Eventually I got it, but it was a struggle. I should have waited until October. And they said I should go back in October. Maybe I could go back in October. I should have waited until then. Bill Gasiamis (28:22) Yeah. Do you kind of like a nervous energy type of person? Do you can’t sit still or is it like, can’t spend a lot of time on your own with yourself? Like, is it? Trisha Lyn Winski (28:34) I can spend a lot of time by myself. don’t like to ⁓ here by myself. I can be by myself. I don’t like to be… I can’t think of… What did you say before? Bill Gasiamis (28:48) Is it just downtime? Is it the downtime? it too much? Did you have too much downtime? Trisha Lyn Winski (28:52) Yes, definitely too much downtime. But I couldn’t see I was sitting at home and Zach was there, whatever he was doing. was like, I can’t, I need to do something. So I went to work and in all reality, I should have walked around. should have, I didn’t do that. Bill Gasiamis (29:04) Yeah. Yeah. How did your colleagues find you when you went back? Did they kind of appreciate what you had been through? Was that easy to have those conversations? What was it like? Trisha Lyn Winski (29:21) Yeah, so I oversaw all the finances department. ⁓ They were actually like, honestly like rock stars. They were like really, really good to me. ⁓ That was helpful. because I love them anyway. it made me feel good to say that that’s what I’m doing. ⁓ But I still left there and cried. Not because like I think that I just couldn’t understand it. They were good to me. Everyone was good to me in theory, I couldn’t understand. Bill Gasiamis (29:56) you had trouble with the work, with doing your job because of your cognitive function. Trisha Lyn Winski (29:59) Yeah, yeah, yeah, there’s a other little things with that, it’s more or less the cognitive function is a problem to do the work. Bill Gasiamis (30:12) Yeah. Tiring. Like I mentioned, it’s really mentally draining and tiring. remember sitting in front of a computer trying to work out what was going on on the screen and it being completely just blank. Acceptance and Coping with Mortality Trisha Lyn Winski (30:22) And so that’s actually what probably got me the most was that what you’re saying. I’d be sitting there and look at my screen. I couldn’t remember what I was doing, but I remember like weird things. I remember how to do like Excel. I don’t know how I remember Excel, but I did. I was really good with numbers. And they said that I was going to have a problem with numbers and everything. So I have aphasia too. I don’t have a choice with that, but Bill Gasiamis (30:31) Yeah. Trisha Lyn Winski (30:49) That’s why I talk so weird. Bill Gasiamis (30:52) Okay, I didn’t notice. Trisha Lyn Winski (30:54) Oh, oh, I feel good. But yeah, I have aphasia. But I can do certain things. And the numbers was going to be, they said it going to, I couldn’t, that’s going to be a problem. And the numbers, I can do all day. But I can’t do other little things. Bill Gasiamis (31:11) I understand. So you went back to work. It was kind of helpful, probably too early to go back, but good to be out of the house. Good to be connecting with people again. And has that improved? Did you find that you’ve been able to kind of get better in front of a screen, better with the things that you struggled with, or is it still still a bit of a challenge? Trisha Lyn Winski (31:19) Yeah. Yeah. So two things, ⁓ I got fired eventually, and that’s another whole issue. Yeah, yeah, we’ll talk about that another time. but ⁓ so, but now that I’m here, I could look my computer and it’s fine. I can do it all day. But I really, it’s a long story. think that Warren, my boss, ⁓ Deb, but they definitely like hinder me. ⁓ Bill Gasiamis (31:39) Understand. another time. Yeah. Okay. I understand. Well, maybe we won’t talk about it, like, because of the complications with that, but that’s all good. I understand. So, ⁓ do you know, a lot of the times you hear about acceptance and you hear about, ⁓ like, Trisha Lyn Winski (32:07) Yeah. Yeah. Yeah. Bill Gasiamis (32:23) When some, well, something goes through something serious, something difficult, you know, there has to be kind of this acceptance of where they’re at. And that’s kind of the first stage of healing recovery, overcoming. Where are you with all of this? you like, totally get that at 46. It’s a shock to have a stroke. You look perfectly fine, perfectly healthy. This thing that you didn’t know about that you’ve had for 46 years suddenly causes an issue. How do you deal with your mortality and knowing that things can go wrong, even though you’re not aware of, you you’re not doing anything to really make your situation worse. You look fit and healthy. Were you drinking, smoking, doing any of that kind of stuff? Trisha Lyn Winski (33:06) I drank occasionally, I wasn’t a drunk, I don’t smoke. Bill Gasiamis (33:11) yeah social smoke social drinker but not smoker Trisha Lyn Winski (33:15) Yeah, I don’t smoke. I don’t have anything that could cause it. I have nothing that, no blood pressure, no diabetes, It’s hard. Jason talks about it all the time. It’s hard. don’t… It makes me mad. Really mad. Really, really mad that I to stroke. And like, everyone that has it… Bill Gasiamis (33:24) Yeah. Trisha Lyn Winski (33:41) or every dozen. I’m like, why me? Why did I have to have it? It’s frustrating. It’s so frustrating. Bill Gasiamis (33:48) Yeah, mad at who? Trisha Lyn Winski (33:50) I don’t know. I’m just mad. Like, I don’t know who I’m mad at. Bill Gasiamis (33:56) Yeah. The thing about the why me question, it’s a fair question. asked it too. I even ask it now sometimes, especially when, um, I’ve got to go back for more tests, more, uh, now I’ve got high blood pressure. Like, like I needed another thing to have, you know, like, and it’s like, the only thing that I come back with after why me is why not me? Like, who are you to go through life completely unscathed and get to 99 and then die from natural Bill Gasiamis (34:25) wanted to stop there for a second because that question, why me, is something I wrote about in my book. It’s one of the most common and most painful places stroke survivors get stuck. If you want to read about it and how I worked through it and what I found on the other side, the book is called The Unexpected Way That a Stroke Became the Best Thing That Happened and it’s available at You’ll find the link in the show notes. And now let’s get back to Tricia. Bill Gasiamis (34:54) like Trisha Lyn Winski (34:54) Yeah. Bill Gasiamis (34:55) You’re normal. being normal, ⁓ normal things happen to people. Some of those things that are shit are strokes and heart attacks and stuff that you didn’t know that you were born with. ⁓ what’s really interesting though, is to live the life after stroke and to kind of wrap my head around what that looks like. My left side feels numb all the time. ⁓ tighter, ⁓ has spasticity, but nothing is curled. Like my fingers on my toes are not curled, but it’s tighter. ⁓ it hurts. ⁓ It’s colder, it’s ⁓ sensitive, I’ve got a, and I always have a comparison of the quote unquote normal side, the other side, it’s always. And the comparison I think is worse because it makes me notice my affected side and that noticing it. Trisha Lyn Winski (35:31) Yeah. or yeah. Bill Gasiamis (35:46) makes the reality happen again every day. Like it’s a new, I wake up in the morning, I get out of bed, my left side still sleepy. I have to be careful. If I’m not careful, I’ll lose my balance. I don’t want to fall over. And it’s like, I get to experience a different version of myself. And sometimes I want to be grateful for that. want to say, wow, what a cool, different thing to experience in a body. But then I’m trying to work out like, what’s the benefit of it? don’t know if there’s a benefit. ⁓ Trisha Lyn Winski (36:14) I don’t know either. Bill Gasiamis (36:15) to me, but, Trisha Lyn Winski (36:15) I don’t either. Bill Gasiamis (36:18) but here I am talking to you and, and, and 390 people before you, ⁓ about strike all over the world and we’re putting something out and it’s making a difference. And maybe that’s the benefit. I don’t know, but do know what I mean? Like, why not us? I hate asking that question too. Trisha Lyn Winski (36:34) I don’t know. You had ⁓ the podcast on YouTube and I stumbled upon it on the wise. I watched YouTube and then you came out there and I’m like, so before that I was looking at different, I watched every video, every video on strokes, every video I could possibly type but I watched. I did. ⁓ And then I stumbled upon your stuff and I watched that stuff too. And that’s why I wouldn’t have thought to call you or reach out to you. Bill Gasiamis (37:11) Was it helpful? Was it helpful? Trisha Lyn Winski (37:13) Yeah, it is helpful. But it doesn’t change the fact that I had a stroke. All the people that had it, I feel bad for them. Honestly, like, so when I was at the hospital, they had me join a bunch of groups on Facebook and Instagram that are like, they’re people who’ve gone through a stroke. most, I don’t comment on them. I don’t say, because most of the time it’s people bitching. Bill Gasiamis (37:19) Yeah. Yeah. Trisha Lyn Winski (37:43) But I really like, times I, trust me, I’m like ready to kill somebody. But I don’t like say it there. I only ask them questions that are really serious. But sometimes I read what they say. And there was a guy the other day, I don’t know what he wrote, but he had like all kinds of words that they were way jumbled. was like, his message just didn’t make sense. I thought to myself, God, if I was like that, I’d be so sad. Somebody, I do think that he’s worse than I could be, but you don’t know. Bill Gasiamis (38:19) Yeah. Communication Challenges and Aphasia Yeah. He, his words are more jumbled than yours. And you, if you, you, you’re thinking, if you were like that, you would be probably feeling more sad than you currently are. And you’re assuming that maybe that person is feeling sad, but maybe they’re not, maybe they just got the challenge and they’re taking on the challenge and they’re trying to heal and recover. don’t know. And maybe, maybe they’re getting help and support through that therapy and also maybe psychological help and all that kind of stuff. Have you ever had any counseling or anything like that to sort of try and wrap your head around what the hell’s going on in your life? Trisha Lyn Winski (38:54) So I did it once and actually like I think she was okay. I felt like I was always having to talk. I know that I’m so stocked but she wasn’t asking me a lot of questions and I felt like she needs to me more questions. I’ll have more answers but like but she didn’t. She just wanted me to talk so I just talked. But I stopped seeing her because I… So two reasons. I stopped seeing her because they when they fire me I… I didn’t know what I had to do. I knew I insured that I didn’t know how long it was going to be for me to have that. So I talked to her for a little bit and then I stopped talking to her because I just couldn’t deal with it. I think now I’m getting to the point where I’m going to do it. Bill Gasiamis (39:37) It was a bit early. I like that. I like what you said there. Cause sometimes it’s early. It’s too early to go through that and unwrap it. Right. And now a little bit of times past, you probably have more conscious awareness of, do need to talk about this and I need to go through and see a certain person. And now I’m going to take that action. It’s been three years and now I can take that action. like it. ⁓ and I like what you said about, you have to feel like you’re connected to that person or you have rapport or Trisha Lyn Winski (39:46) It is. Yeah. Yeah. Yeah. Yeah. Bill Gasiamis (40:11) they get you and you’re not just, it’s not a one way conversation. That’s really important in choosing a counselor. I know my counselor, we, I didn’t do all the talking. was like you and me chatting now about stuff. had a conversation about things regularly. And therefore, ⁓ one of the good things that she was able to do was just ease my mind when I would go off on real negative tangents, you know, she would try to bring me back down just to calm and. Trisha Lyn Winski (40:35) Yeah. Bill Gasiamis (40:39) settle me down and offer me hope. Trisha Lyn Winski (40:42) I think my, honestly my biggest problem with this whole stroke and having it at all, I have aphasia and that 100 % kills me. Because I can’t like, I can talk like normal but I can’t talk like… I forget what I’m saying. So it’s in my brain, but I can’t spit it out. I get really frustrated at that point. people, I had a stroke, my left hemisphere and my right side went numb. My left hemisphere is all kinds of different, different things that I can’t do. The good news is my left means I can’t like, I can talk to people like this. But the other person and that guy I was talking about, he probably had the right side, his aphasia was. really bad, really bad. But I was a person who talked like really fast all the time, all the time. And now like, I think part of my brain goes so fast and I can’t spit it out. I get really, I get, it’s, yeah. Bill Gasiamis (41:38) Okay. as quickly as you can. Okay, so you know, I’ve spoken to a ton of people who have aphasia. And one of the things they say to me is when they have frustration, their aphasia is worse. So the skill is to learn to be less frustrated with oneself, which means that’s like a personal love thing. That’s self love, that’s supporting yourself, you know, and going. Trisha Lyn Winski (42:00) It is. The Journey of Recovery and Self-Discovery Yeah, that’s a point. That’s a good point. Bill Gasiamis (42:13) And it’s going like, well, you know, you’re trying your best. It’s all good. You know, don’t get frustrated with yourself. Don’t hate yourself. Don’t give yourself a hard time about it. ⁓ and try and decrease the frustration. Then the aphasia gets less impactful, but, ⁓ and then maybe, you know, this part of learning the new you is bring the old Trisha with you, but maybe the nutrition needs to be a little bit more slow, a little more measured, a little more calm. And it’s a skill because for 46 years, you were the regular. Trisha Lyn Winski (42:36) Yeah. Bill Gasiamis (42:42) Tricia, the one that you always knew, but now you’ve got to adjust things a little bit. It’s like people going into midlife, right? Like us, you know, in our fifties and then, um, or, know, sort of approaching 50 on and beyond and then go, I’m going to keep eating, uh, fast food that I ate when I was 21 and 20, know, McDonald’s or sodas or whatever. You can’t do it anymore. You have to make adjustments, even though that’s been your habit for the longest time, your body’s going, I can’t deal with this stuff anymore. Trisha Lyn Winski (43:03) Yeah. Bill Gasiamis (43:12) Take it out, you know, let’s simplify things. And it’s kind of like how to approach. I stroke recoveries things need to kind of get paid back and simplified. And it has to start with self love. And you have to acknowledge how much effort you’ve already put in for the last three years to get you to the position that you are now, which is far better than you were three years ago when the stroke happened. And you have to celebrate. how much your body is trying to support you heal your brain. Your body’s trying to get you over the line and your mindset is getting frustrated with itself, which is making things worse. Tweak that and things will get a bit better maybe. I don’t know. Trisha Lyn Winski (43:55) It does. You’re 100 % right. ⁓ So whenever I’m not stressed, so two things. I think when I talk to people I don’t know, I always get like nervous about that. ⁓ Bill Gasiamis (44:10) You think they’re thinking about things that you’re not they’re not really Trisha Lyn Winski (44:13) Yeah, but then who knows what they’re thinking of. that’s just how I get, whenever I get like, I went to a concert like a couple of years ago and I was like, I believe I couldn’t, I could hear that the music is so loud in my brain. Like I gotta get out of here. So I left. I’ve gotten better since then, but there’s something about, I have to do things slower. I have to do things over. I’ve realized that like recently, like in the last like maybe month, I have to do things very slow. I have to. And maybe this is God’s way of like, tell me like slow the f down, you’re going too fast. But that’s how I live my whole life. And then all of a sudden, now you’re not going to get up. Yeah, it’s a huge testament. So I can do it right. Not always right. Bill Gasiamis (45:01) Yeah, there’s an adjustment. Yeah, adjustment. Yeah. Trisha Lyn Winski (45:09) because again, it’s isophagia, it’s gonna be hair mess, if I go slower, much slower, I can get it all out. But, ugh. Bill Gasiamis (45:22) It’s a lot of work, man. It doesn’t end here. You know, the work just as just beginning, you know, this getting to understand yourself, to know yourself, to support yourself, to be your biggest advocate. ⁓ and then to fail and then to try and be the person that, ⁓ picks themselves up and goes again and tries again without getting frustrated. I know exactly what you mean. Like so many people listening will know what you mean. Trisha Lyn Winski (45:22) It’s a pain. It’s a pain! Bill Gasiamis (45:51) And with time, you’ll get better and better because I know that three years seems like a long time, but it’s early in the recovery phase. The recovery is still going to continue. Year four, five, six, seven will be better and better and better. I’m, I’m 12 years post brain surgery and 14 years post first incident. So it’s like, things are still improving and getting better for me. Trisha Lyn Winski (46:17) Yeah. Bill Gasiamis (46:18) And one of the things is the way that my body responds to physical exercise. went for a bike ride a little while ago, a couple of weeks ago. And when I used to go for a bike ride at the beginning, um, man, I would be wiped out for the entire day. Uh, and I used to do a morning bike ride about like 10, 30, 11 o’clock and I’d be wiped out for the rest of the day. Trisha Lyn Winski (46:32) Yeah. Bill Gasiamis (46:39) Whereas now I can go for a bike ride and just be wiped out like a regular person, you know, about an hour or two, and then I’m back on board with doing other tasks. So it takes so much time for the brain to heal. Nobody can give you a timeline and you’ve got heaps more healing to go. Trisha Lyn Winski (46:57) So I looked at my stuff on YouTube, how long it takes to recover from a stroke. I’ve looked at that everywhere. Everywhere I can find. I’ve looked at that. It’s so funny. Like everybody says that it’s, everybody’s story is different. Everybody. It doesn’t matter how long you were in hospital for, doesn’t how long. But that like, it’s crazy. have no like timetable of when I’m going to get better. None. I have to deal with it. Bill Gasiamis (47:27) Yeah. It’s such a hard thing. It’s not a broken bone, know, like six weeks, stay off it, do a little bit of rehab and then you’re back to normal. Trisha Lyn Winski (47:28) It sucks, but. I had two years before this or maybe a year before that, had a rotator cuff surgery. I look back at that and I’m like, that was so bad. And that was like night and day. The stroke definitely like, the stroke killed me. Not the stroke. I don’t want to say the stroke. I think having aphasia killed me. I do, the stroke is, get me wrong. I don’t like it either, but ⁓ the aphasia kills me. If I didn’t have that, I wouldn’t be normal, but I can be normal. But the aphasia. Bill Gasiamis (48:00) Okay. Yeah. But, but what, but that word killed me is a real heavy word, right? maybe you should consider changing that word, but also like, didn’t pick that you had aphasia and I, and I speak to stroke survivors all the time. Like I didn’t pick it. I, I just assumed that was the way you process your words and that’s how you get things out. Like it didn’t, I didn’t notice it at all. Trisha Lyn Winski (48:26) I know, I know, it’s funny that said Yeah, that’s actually good. That’s really good. But I know it’s it. I definitely know it’s it. I could talk like a mile a minute and now like. Bill Gasiamis (48:47) Yeah. Trisha Lyn Winski (48:52) I mean… Bill Gasiamis (48:52) Maybe it was maybe maybe now it’s more about ⁓ quality rather than quantity, Trisha. Trisha Lyn Winski (49:00) Apparently it is. Bill Gasiamis (49:01) I’m not saying that you didn’t have quality in that I didn’t know you so I’m not kind of yeah but you know what I mean like Trisha Lyn Winski (49:03) Yeah. No, it’s okay. Trust me, it’s okay. But yeah, it just frustrates me. I can’t get out what I want to get out. And so at that time, just give me a little time, I’ll get it out. But I can’t say that to people when I’m out. I can’t say this to So I just, I don’t say it at all. Bill Gasiamis (49:22) Yeah. so you stop yourself from communicating because you think you’re taking too long and it’s interrupting the flow of the conversation. Yeah. I think you’re doing that to yourself. I don’t think that’s true. We’ve had a fantastic conversation here and I’ve never picked it. Trisha Lyn Winski (49:34) Yeah. all day. But so you’re somebody who’s had a stroke before. It’s kind of different for me because you had. But if you didn’t have a stroke, will be… Well, I don’t know. Maybe not. Maybe one-on-one I’m okay. No, think I… No, it’s because you had a stroke. I think of all the people I’ve talked to and they’re one-on-one. I don’t do well with them. But I think that you’ve had a stroke so I just… I know how to communicate with you. Bill Gasiamis (49:54) I understand. And maybe you’re more at ease about it. Less feeling, judged. I understand. Yeah. Trisha Lyn Winski (50:20) Yes, all day. Even that guy I told you about that that said that on Facebook God like I Really like my heart goes out to him But then that there’s the people that are fishing a plane I’m like I want to say my heart goes out to them, it really, it goes to certain people. I think that. He’s like going through it. Bill Gasiamis (50:45) Yeah. One of the problems with going to Facebook to bitch and moan about it, especially when you’re going through it is that you get an abundance of people who also are there to bitch and moan about it. And, and that makes it worse. think you should do bitching and moaning on your own. Like when there’s no one watching or listening. Cause then that way there’s not a loop of bitching and moaning that happens. That makes it dramatically worse for everybody. Trisha Lyn Winski (51:01) Yeah, I do it myself. Bill Gasiamis (51:09) ⁓ and that’s why I don’t hang around on Facebook, Instagram, social media, or anything like that for those types of conversations. If I’m not sharing a little bit of wisdom or somebody’s story or, ⁓ asking a question, like a genuine question, one of the questions might be, did you struggle driving and did you have to pull over and go to sleep in the middle of the road? If you had a big trip ahead of you in the car, I’ve done that. Like if, if I’m not asking a question like that, I don’t want to be, ⁓ on social media saying. life sucks, this sucks, that sucks. Like forget about it. What’s the point of that? That’s why I started the podcast so I can have my own conversations about it that were positive based on what we’re overcoming rather than all the shit we’re dealing with. And that way ⁓ we take off that spiral, the negative downward spiral. trying to make it an upward spiral. You know, where things are. Trisha Lyn Winski (51:41) Yeah. Facing the Aftermath of Stroke Bill Gasiamis (52:05) I don’t know, we’re seeing the glass half full perhaps, or we’re seeing the positive that came out of it. If something like, I know there’s some positive stuff that came out of stroke for you. Day one, you definitely didn’t think that maybe three years down the track. Maybe if it wasn’t for this, well, then that wouldn’t have happened for me. Like I’ve been on TV. I’ve been at the stroke foundation. I’ve been on radio. I’ve been, I’ve presented. I’ve got a podcast. wrote a book. Like it’s taken years and years for all those good things to come, but they never would have happened if I didn’t have a stroke. So I wanted to have those types of conversations, you know, what are the positive things we can turn this into? Because dude, then there’s just enough shit to deal with that. We don’t have to deal with every other version of it, you know? ⁓ and I think it’s better to have your me personally, my negative moments alone, cause I don’t want to get into a competition with somebody. Trisha Lyn Winski (52:42) That’s good. Yeah. Bill Gasiamis (53:05) who I say, I didn’t sleep well, my left side hurts, it feels like pins and needles. And then they say to me, ⁓ you think that’s bad? Well, you know, forget about it. I don’t want to be that that guy on the other end of a conversation like that, you know. Trisha Lyn Winski (53:13) Yeah. ⁓ So you said your left side, ⁓ you see you have pin the needles, is always like that? So I’m sorry, had hemorrhagic stroke? Okay. I know the difference between two, ⁓ why did you have hemorrhagic stroke? Bill Gasiamis (53:27) Always, yeah, never goes away. Yeah, Brain blade. I was born with a blood vessel that was malformed. So it was like really weak one. I was really like, uh, was kind of like, uh, uh, it wasn’t created properly in my brain when I was born and it’s called an arteriovenous malformation. then they sit idle, they sit idle and they do nothing for a lot of people. And then sometimes they burst. Trisha Lyn Winski (53:58) Mm-hmm. ⁓ I heard it. Bill Gasiamis (54:08) And people sometimes have them all over their body. They don’t have to have them in their head. They can have them on the skin, ⁓ in, in an arm on a leg, wherever. And on an arm and a leg, they, they decrease the blood flow and they create real big lesions of skin damage on the surface in a brain. They leak into the brain and they cause a stroke. ⁓ so the challenge with it is like you, there was no signs and symptoms. for any of my life until it started bleeding. And when I took action, eventually, I was like, yo, I didn’t want to go to the doctor. I didn’t want to go to the hospital. I want to do any of that. It took seven days for me to go to the hospital. When I finally got there, they found the scan, found the blood in my head. And then they thought it would stop bleeding and it didn’t. And then it bled again and they wanted to monitor it to see if it stops bleeding. They wanted to try to avoid surgery. And then a bled a third time. And then after they bled the third time, they said, we have to have surgery. We’ve got to take it out because it’s too dangerous. And when it bled the second time, I didn’

Dr. Priyadarshee Patel, with Willis-Knighton Interventional and Vascular Neurology, joins Healthline 3 to discuss how to recognize and treat carotid artery disease.

In this AJNR Article Summary, Dr. George Vilanilam discusses the article, "Biphasic Progression of Radiation-Induced Carotid Stenosis: The Predictive Role of Low-Density Plaque". Low‑density carotid plaque on imaging may signal accelerated stenosis progression in post‑radiation patients, highlighting the need for earlier intervention and a shift toward evaluating plaque composition, not just degree of narrowing, to help prevent stroke in this high‑risk group.

Join Mark, Kate, Henry and Gary as they discuss 4 new POEMs (Patient Oriented Evidence that Matters, studies with the potential to change practice): a summary of the evidence on tirzepatide (Zepbound) for weight loss, using the Beers list with your patients, high vs standard dose flu vaccine and the risk of hospitalization, and whether stent or endarterectomy are better than maximal medical therapy for patients with asymptomatic carotid stensosis. Here are the links:Essential Evidence Plus: www.essentialevidenceplus.comTirzepatide systematic review: https://pubmed.ncbi.nlm.nih.gov/41015578/ Tirzepatide vs dulaglutide: https://pubmed.ncbi.nlm.nih.gov/41406444/Applying the Beers list: https://pubmed.ncbi.nlm.nih.gov/40697073/ High vs standard dose flu vaccine: https://pubmed.ncbi.nlm.nih.gov/41115437/ Another high dose flu trial: https://pubmed.ncbi.nlm.nih.gov/39230284/ Asymptomatic carotid stenosis treatment: https://pubmed.ncbi.nlm.nih.gov/41269206/

Carotid Artery Ultrasound and Longevity The opposite of longevity is death. If longevity is what we seek we must obsess about death, and those things that increase the risk of us dying. #1 Killer – Cardiovascular DiseaseCardiovascular disease is the biggest killer on the block claiming the lives of 1 in every 3 people worldwide. Almost 1 million people a year die from cardiovascular disease in the United States alone, often due to events like heart attacks and strokes. The main cause of cardiovascular disease is atherosclerosis.  Atherosclerosis Thickening and hardening of the artery walls caused by the deposition of plaque (made of cholesterol, fats, other materials) into the blood vessel walls. Plaques can slowly grow causing occlusion of a blood vessel (stenosis). Plaques can also rupture, leading to blood clots (ischemic heart attacks, strokes, and other infarctions). Plaques can also break away from the walls, forming emboli (also causing ischemic heart attacks, strokes, and other infarctions). Infarction: Obstruction of blood supply to an organ or region of tissue (usually from a blood clot or embolis) Thickening of blood vessel walls, plaques, and restriction of blood flow can all be visualized using Carotid ultrasound. In the body, if blood vessel disease (e.g. atherosclerosis) is seen at one area, it is likely present in other areas as well. As such: Carotid Ultrasound is a very important Longevity Metric. For the complete blog post check out fullscope.org/blog or longetrics.org/blog

Carotid artery disease management has come a long way. From the days when every stroke meant an endarterectomy to a modern era defined by precision, evidence, and evolving technology. With advances in medical therapy and newer techniques like TCAR, the vascular surgeon has even more to consider when choosing the best treatment for carotid disease. Join us as we break down the major landmark trials NASCET, CREST and the Asymptomatic Carotid trials, and discuss how their findings shape our clinical decisions in practice today. Hosts: ·      Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center ·      Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center ·      Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center ·      Lucio Flores, Vascular surgery, Brookdale Hospital Medical Center Learning Objectives: · Review the key findings and clinical implications of the NASCET, ACST, and CREST trials. · Discuss patient selection for carotid endarterectomy (CEA) vs carotid artery stenting (CAS). · Understand how age, calcification, and aortic arch anatomy affect stenting outcomes or choice between stent and CEA. · Identify how advances in medical therapy have influenced management of asymptomatic disease.  · Discuss appropriate screening/ follow up plans for patients who do not meet criteria for intervention References: -       North American Symptomatic Carotid Endarterectomy Trial Collaborators. (1991). Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. The New England Journal of Medicine, 325(7), 445–453. https://pubmed.ncbi.nlm.nih.gov/1852179/ -       Brott, T. G., Hobson, R. W. II, Howard, G., Roubin, G. S., Clark, W. M., Brooks, W., ... & Howard, V. J. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. The New England Journal of Medicine, 363(1), 11–23. https://pubmed.ncbi.nlm.nih.gov/20505173/ -       Halliday, A., Mansfield, A., Marro, J., Peto, C., Peto, R., Potter, J., & Thomas, D.; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. (2004). Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: Randomized controlled trial. The Lancet, 363(9420), 1491–1502. https://pubmed.ncbi.nlm.nih.gov/15135594/ -       Halliday, A., Bulbulia, R., Bonati, L. H., Chester, J., Cradduck-Bamford, A., Peto, R., & Pan, H., & the ACST-2 Collaborative Group. (2021). Second asymptomatic carotid surgery trial (ACST-2): A randomised comparison of carotid artery stenting versus carotid endarterectomy. The Lancet, 398(10305), 1065-1073. https://doi.org/10.1016/S0140-6736(21)01910-3 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Review of vagal maneuvers and alternative treatments used in ACLS for stable patients with tachycardia at a rate over 150 bpm.Narrow complex tachycardia with a rate over 150 BPM.Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock.Assessment & treatment of stable tachycardic patients.Commonly used vagal techniques.A less common technique to stimulate the vagus nerve.Indications and use of Adenosine.Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.Carotid sinus massage.Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. **American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

In this episode, we review the high-yield topic Carotid Stenosis⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Cardiovascular section at ⁠⁠⁠⁠Medbullets.com⁠⁠⁠⁠⁠⁠Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets

Send us a textIn this episode of WTR Small-Cap Spotlight, host Tim Gerdeman and WTR's Robert Sassoon speak with Marvin Slosman, CEO of InspireMD (NASDAQ: NSPR), to discuss how the company is transforming carotid artery disease treatment with its groundbreaking CGuard® Prime Carotid Stent System. The conversation covers FDA approval, clinical data, market adoption, competitive positioning, and InspireMD's long-term growth strategy.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on The Cumulative Atherogenic Index of Plasma Exposure in Carotid Plaque: A Cohort Study in China.

From new techniques to evolving best practices–are you up to date with the latest developments in carotid artery stenting? In this episode, Dr. Wayne Olan, Interventional Neuroradiologist and the director of Minimally Invasive Neurosurgery at George Washington University joins Dr. Michael Barraza for a discussion on the latest innovations and evolving techniques in carotid artery stenting.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISDr. Olan opens the conversation with a historical perspective on the evolution of carotid stenting, tracing advancements from early techniques to modern devices. He then talks through referral patterns, noting that the majority originate from cardiologists. Dr. Olan emphasizes the importance of meticulous periprocedural planning and comprehensive post-procedural management. Central to this discussion is the critical role of antiplatelet therapy, including strategies for addressing Plavix non-responders, such as the use of Integrilin. The discussions also covers advanced techniques in carotid artery stenting, including the utilization of the Aptus sheath and the Contego stent system. He underscores the importance of mastering the available tools, understanding patient-specific factors, meticulous procedural planning, and always maintaining a contingency plan. He concludes the discussion by exploring emerging trends and the future potential of outpatient carotid stenting.---TIMESTAMPS00:00 - Introduction02:44 - The Importance of Stroke Intervention07:16 - Carotid Stenting: Evolution and Techniques13:29 - Challenges and Collaborations in Carotid Interventions16:17 - Technical Insights and Best Practices25:24 - Choosing the Right Wire for Carotid Procedures25:53 - Anticoagulation and Filter Wire Techniques28:30 - Managing Stent Placement and Distal Protection30:54 - Handling Carotid Bifurcation and Skull Base Lesions38:43 Dealing with Tandem Occlusions42:06 - Future Trends in Outpatient Procedures44:43 - Addressing Re-stenosis and Vertebral Lesions45:44 - Conclusion and Final Thoughts

Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients.Commonly used vagal techniques.A less common technique to stimulate the vagus nerve. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.Carotid sinus massage.Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. **American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Commentary by Dr.  Jian'an Wang.

In this powerful episode, I sit down with Dr. Jeremy London—a board-certified cardiothoracic surgeon with over 26 years of experience—to uncover the often-overlooked truths about cardiovascular disease, especially in women. Dr. London shares why menopausal women face triple the risk for heart disease, and what you can do to protect yourself. From the life-saving power of simply moving your body to the three essential tests everyone should be asking for, this conversation breaks down complex health topics into clear, actionable steps. Whether you're navigating midlife or looking to take preventative measures, this episode is a must-listen for anyone ready to take control of their heart health. About Dr. Jeremy London: Dr. Jeremy London is a Board-Certified Cardiothoracic Surgeon with over 26 years of clinical experience. He earned his medical degree from the Medical College of Georgia and completed his surgical training in Denver and Charlotte. A passionate advocate for patient education, Dr. London is on a mission to make health information more accessible through his newsletter, podcast, and social media. He lives in Savannah, Georgia with his wife and their three sons. *** Subscribe to The Neuro Experience for more conversations at the intersection of brain science and performance. I'm committed to bringing you evidence-based insights that you can apply to your own health journey. *** A huge thank you to my sponsors for supporting this episode. Check them out and enjoy exclusive discounts: Caraway: www.caraway.com/neuro for an additional 10% off your purchase LMNT:Use code drinklmnt.com/neuro to get a free 8-count Sample Pack of LMNT's most popular drink mix flavors with any purchase. MUDWTR - The coffee alternative. If you're ready to ditch the crash and sip smarter, go to mudwtr.com and use code NEURO to get 43% off + free shipping. David's Protein: Buy four cartons and get your fifth one completely free | Head to www.davidprotein.com/neuro Branch Basics: www.branchbasics.com to shop their Premium Starter Kit and save 15% | Code: NEURO *** Topics discussed: 00:00:00: Why women's cardiovascular risk triples after menopause 00:03:40: Two out of three Alzheimer's disease patients are women 00:04:47: What are lipid panels 00:05:20: Cardiovascular disease is the number one cause of death worldwide 00:06:13: The three buckets of heart disease 00:07:27: Cholesterol 00:08:47: ApoB 00:10:15: Plaque 00:10:53: Lp(a) 00:14:39: Louisa's mother's lab results 00:16:09: Going beyond lab work: Screen tests 00:17:39: Cardiac catheterization 00:19:49: Carotid ultrasound 00:21:07: What is atrial fibrillation and how is it diagnosed? 00:26:37: What you can do yourself to diagnose Afib 00:31:14: What was COVID like in the cardiovascular department? 00:35:47: Blood pressure 00:41:48: AI in the medical field 00:48:07: Exercise to minimize risk of cardiovascular disease 00:53:21: Healthy nutrition to minimize risk of cardiovascular disease 00:55:01: Can supplement eliminate plaque? 00:56:09: Changing our lifestyle and diet to mitigate diseases 00:57:31: Sleep quality to minimize risk of cardiovascular disease *** I'm Louisa Nicola — clinical neurophysiologist — Alzheimer's prevention specialist — founder of Neuro Athletics. My mission is to translate cutting-edge neuroscience into actionable strategies for cognitive longevity, peak performance, and brain disease prevention. If you're committed to optimizing your brain — reducing Alzheimer's risk — and staying mentally sharp for life, you're in the right place. Stay sharp. Stay informed. Join thousands who subscribe to the Neuro Athletics Newsletter → https://bit.ly/3ewI5P0 Instagram: https://www.instagram.com/louisanicola_/ Twitter : https://twitter.com/louisanicola_ Learn more about your ad choices. Visit megaphone.fm/adchoices

In this powerful episode, I sit down with Dr. Jeremy London—a board-certified cardiothoracic surgeon with over 26 years of experience—to uncover the often-overlooked truths about cardiovascular disease, especially in women. Dr. London shares why menopausal women face triple the risk for heart disease, and what you can do to protect yourself. From the life-saving power of simply moving your body to the three essential tests everyone should be asking for, this conversation breaks down complex health topics into clear, actionable steps. Whether you're navigating midlife or looking to take preventative measures, this episode is a must-listen for anyone ready to take control of their heart health. About Dr. Jeremy London: Dr. Jeremy London is a Board-Certified Cardiothoracic Surgeon with over 26 years of clinical experience. He earned his medical degree from the Medical College of Georgia and completed his surgical training in Denver and Charlotte. A passionate advocate for patient education, Dr. London is on a mission to make health information more accessible through his newsletter, podcast, and social media. He lives in Savannah, Georgia with his wife and their three sons. *** Subscribe to The Neuro Experience for more conversations at the intersection of brain science and performance. I'm committed to bringing you evidence-based insights that you can apply to your own health journey. *** A huge thank you to my sponsors for supporting this episode. Check them out and enjoy exclusive discounts: Caraway: www.caraway.com/neuro for an additional 10% off your purchase LMNT: Use code drinklmnt.com/neuro to get a free 8-count Sample Pack of LMNT's most popular drink mix flavors with any purchase. MUDWTR - The coffee alternative. If you're ready to ditch the crash and sip smarter, go to mudwtr.com and use code NEURO to get 43% off + free shipping. David's Protein: Buy four cartons and get your fifth one completely free | Head to www.davidprotein.com/neuro Branch Basics: www.branchbasics.com to shop their Premium Starter Kit and save 15% | Code: NEURO *** Topics discussed: 00:00:00: Why women's cardiovascular risk triples after menopause 00:03:40: Two out of three Alzheimer's disease patients are women 00:04:47: What are lipid panels 00:05:20: Cardiovascular disease is the number one cause of death worldwide 00:06:13: The three buckets of heart disease 00:07:27: Cholesterol  00:08:47: ApoB 00:10:15: Plaque 00:10:53: Lp(a) 00:14:39: Louisa's mother's lab results 00:16:09: Going beyond lab work: Screen tests 00:17:39: Cardiac catheterization  00:19:49: Carotid ultrasound  00:21:07: What is atrial fibrillation and how is it diagnosed? 00:26:37: What you can do yourself to diagnose Afib 00:31:14: What was COVID like in the cardiovascular department? 00:35:47: Blood pressure 00:41:48: AI in the medical field 00:48:07: Exercise to minimize risk of cardiovascular disease 00:53:21: Healthy nutrition to minimize risk of cardiovascular disease 00:55:01: Can supplement eliminate plaque? 00:56:09: Changing our lifestyle and diet to mitigate diseases 00:57:31: Sleep quality to minimize risk of cardiovascular disease *** I'm Louisa Nicola — clinical neuroscientist — Alzheimer's prevention specialist — founder of Neuro Athletics. My mission is to translate cutting-edge neuroscience into actionable strategies for cognitive longevity, peak performance, and brain disease prevention. If you're committed to optimizing your brain — reducing Alzheimer's risk — and staying mentally sharp for life, you're in the right place. Stay sharp. Stay informed. Join thousands who subscribe to the Neuro Athletics Newsletter → https://bit.ly/3ewI5P0 Instagram: https://www.instagram.com/louisanicola_/ Twitter : https://twitter.com/louisanicola_

Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.Unstable patients in SVT or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients.Commonly used vagal techniques.A less common technique to stimulate the vagus nerve. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.Carotid sinus massage.Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Send us a textIn this episode of MedStar Health DocTalk, host Debra Schindler speaks with Dr. Othman Abdul-Malak, MD, MSC, a vascular expert, to break down the what carotid artery disease is, and how it can lead to stroke, mini-strokes (TIAs), and sudden vision loss. Learn how to recognize early warning signs—like facial droop, arm weakness, or sudden speech problems—and why acting fast can save brain function. Dr. Abdul-Malak also explains:·       The difference between ischemic and embolic strokes·       What amaurosis fugax means ·       Why age, heart disease, and cholesterol put you at greater risk·       When NOT to take aspirinThis episode is a must-listen for anyone interested in stroke prevention, vascular health, or caring for aging loved ones. Time is brain. Know the signs. Act fast.Subscribe for more expert-led episodes.To make an appointment with Dr. Abdul Malak, call 443-777-1900. If you would like to provide feedback on this podcast or get more information when carotid artery disease or treatment options, send me an to DocTalk@medstar.net For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.

Carotid artery dissection survival story inspiring stroke survivors to keep going, seek rehab, and embrace hope even in the hardest times. The post Carotid Artery Dissection Nearly Took Everything – But I'm Still Standing appeared first on Recovery After Stroke.

Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT.Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients.Commonly used vagal techniques.A less common technique to stimulate the vagus nerve is the dive reflex. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine. Carotid sinus massage.Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Safe Meds VIP - Learn about medication safety and download a free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT. Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients.Commonly used vagal techniques.A less common technique to stimulate the vagus nerve is the dive reflex. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine.Carotid sinus massage.Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT. Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients. Commonly used vagal techniques. A less common technique to stimulate the vagus nerve is the dive reflex. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers. Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine. Carotid sinus massage. Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

How does high physical activity level impact risk of incident carotid plaque components? Dr. Luosiyuan Zuo reported his research on how high physical activity level impacted the risk at ESC Congress 2024 and further discussed this topic based on the abstract for the ESC Congress 2024. Moderated by Dr. Zhangling Chen.

Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT. Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients. Commonly used vagal techniques. A less common technique to stimulate the vagus nerve is the dive reflex. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers.Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine. Carotid sinus massage. Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.   Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as vascular surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. Learn more about the full set of 72 scenarios here: https://app.behindtheknife.org/course-details/vascular-surgery-oral-board-audio-review Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/dp/B0CZ8ZBF83 Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT. Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients. Commonly used vagal techniques. A less common technique to stimulate the vagus nerve is the dive reflex. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers. Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine. Carotid sinus massage. Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

Commentary by Dr. Valentin Fuster

ESC TV Today brings you concise analysis from the world's leading experts, so you can stay on top of what's happening in your field quickly. This episode covers: Cardiology This Week: A concise summary of recent studies Microplastics and nanoplastics in atheromas and cardiovascular events Leadless pacemakers Snapshots Host: Rick Grobbee Guests: Stephan Achenbach, Carlos Aguiar, Emanuele Barbato, Haran Burri Want to watch that episode? Go to: https://esc365.escardio.org/event/1148   Disclaimer This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC.    Declarations of interests  Stephan Achenbach, Emanuele Barbato, Rick Grobbee and Nicolle Kraenkel have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, Lilly, Novartis, Pfizer, Sanofi, Servier, Tecnimede. Haran Burri has declared to have potential conflicts of interest to report: institutional research and fellowship support or speaker honoraria from Abbott, Biotronik, Boston Scientific, Medtronic, Microport. Davide Capodanno has declared to have potential conflicts of interest to report: Abbott Vascular, Novo Nordisk, Sanofi. Terumo, Medtronic. Emma Svennberg has declared to have potential conflicts of interest to report: institutional research grants from Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Boehringer-Ingelheim, Johnson & Johnson, Merck Sharp & Dohme.

Carotid stenosis, caused by a buildup of plaque in the carotid artery, accounts for around 20% of all ischemic strokes. Mark Harrigan, M.D., and Elizabeth Liptrap, M.D., both neurosurgeons, discuss key aspects of medical management and interventions for carotid stenosis. Learn about two new alternatives to the (still-effective) endarterectomy procedure. The doctors explain how their approach to management and intervention varies by patient.

Authors:  Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California Gowri Gowda - PGY1 at the University of California Davis Integrated Vascular Surgery Program Steven Maximus- Vascular surgery attending at the University of California Davis, Director of the Aortic Center   Resources:  Rutherford's 10th Edition Chapters: 88, 89, and 91 The North American Symptomatic Carotid Endarterectomy Asymptomatic Carotid Atherosclerosis Study Audible Bleeding's eBook chapter on cerebrovascular disease Houston Methodist CEA Dissection Video: Part 1: https://www.youtube.com/watch?v=wZ8PzhwmSXQ Part 2: https://www.youtube.com/watch?v=E_wWpRKBy4w   Outline:  1. Etiology of Carotid Artery Stenosis Risk factors: advanced age, tobacco use, hypertension, diabetes. Atherosclerosis as the primary cause. Development of Atherosclerotic Disease and Plaque Formation LDL accumulation in arterial walls initiating plaque formation. Inflammatory response, macrophage transformation, smooth muscle cell proliferation. Role of turbulent blood flow at carotid bifurcation in plaque development. Clinical Features of Carotid Artery Stenosis Asymptomatic nature in many patients. Symptomatic presentation: Transient ischemic attacks, amaurosis fugax, contralateral weakness/sensory deficit. Carotid bruit as a physical finding, limitations in diagnosis. Importance of Evaluating CAS Assessing stenosis severity and stroke risk. Revascularization benefits dependent on stenosis severity. Classification of Stenosis Levels Clinically significant stenosis: ≥ 50% narrowing. Moderate stenosis: 50%–69% narrowing. Severe stenosis: 70%–99% narrowing. Stroke Risk Associated with Carotid Stenosis Annual stroke rate: ~1% for 50-69% stenosis, 2-3% for 70-99% stenosis. Diagnosis and Screening No population-level screening recommendation. Screening for high-risk individuals as per SVS guidelines. Carotid Duplex Ultrasound as primary diagnostic tool. Additional tools: CT angiography, Magnetic Resonance Angiography. Handling of 100 cm/sec, Internal/Common Carotid peak systolic velocity Ratio > 4. Revascularization Criteria Symptomatic Patients: 50-69% or 70-99% stenosis, life expectancy at least three or two years, respectively. Asymptomatic Patients: 70% stenosis, considering life expectancy. Surgical Indications and Contraindications Indications: symptomatic patients, life expectancy considerations. Contraindications: Stenosis

Carotid artery disease occurs when the veins in our neck that carry blood from the heart to the brain get blocked by plaque. This condition can have very serious consequences like a stroke. Transcarotid Artery Revascularization or TCAR is a minimally invasive surgery to treat blockages in the carotid artery, reducing the risk of stroke. Listen to a Q&A discussion about Carotid Artery Disease & TCAR with Mark Janzen, M.D., an Enloe Health vascular surgeon.

Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT. Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients. Commonly used vagal techniques. A less common technique to stimulate the vagus nerve is the dive reflex. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers. Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine. Carotid sinus massage. Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!

Patients with a narrow complex tachycardia with a rate over 150 BPM are in SVT. Unstable patients in SVT, or V-Tach with a pulse, should be cardioverted with a synchronized shock. Assessment & treatment of stable tachycardic patients. Commonly used vagal techniques. A less common technique to stimulate the vagus nerve is the dive reflex. Indications and use of Adenosine for stable patients in SVT refractory to vagal maneuvers. Possible treatments for patients found to be in A-Fib or A-Flutter with RVR after administration of Adenosine. Carotid sinus massage. Additional medical podcasts that have episodes on tachycardia can be found on the pod resources page at passacls.com. Connect with me:Website: https://passacls.com@PassACLS on Twitter@Pass-ACLS-Podcast on LinkedInGive back & support the show:via PayPal Good luck with your ACLS class!

Join us for this months episode of Put Your Heart Into It, as we continue our discussion of Carotid Disease with Dr. Kang. Learn the new treatments for Carotid Disease and how to create the appropriate patient-centered treatment plan.

This week Kate, Mark, Gary and Henry discuss magnesium to prevent cerebral palsy, amoxicillin challenge in the primary care clinic for suspectec PCN non-allergy, new ACP guidance on colorectal cancer screening, and surgery for carotid disease.

Dr. Kang joined us for a discussion regarding Carotid Disease and the pathway for screening and helping to prevent strokes in patients. 

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In this episode, we review the high-yield topic of ⁠Carotid Dissection⁠⁠ ⁠⁠⁠from the Cardiovascular section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Dr. Tanu Garg discusses the diagnosis of carotid web.

Modern-day evidence-based medicine mandates a strong understanding of current local and international guidelines. Surgeons rely heavily on these reports, but what to do when they differ? We have partnered with the ESVS podcast in creating the Transatlantic Series, where we compare and contrast our respective society guidelines. In this inaugural episode, we explore the SVS carotid artery disease guidelines published in 2022 and the recently updated ESVS guidelines published in 2023. Representing the American perspective, we are excited to speak with Dr. Ali AbuRahma. Dr. AbuRahma is the former president of the Society of Vascular Surgery, the Chief of Vascular and Endovascular Surgery at the Charleston Area Medical Centre at West Virginia University, and the corresponding author of the latest SVS guidelines on extracranial cerebrovascular disease. Representing the European perspective, we are delighted to speak with Dr. Barbara Rantner. Dr. Rantner is the co-chair of the 2023 European Society of Vascular Surgery Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease and a leading physician at the Ludwig-Maximillian University Hospital in Munich, Germany. Further reading and links: The North American Symptomatic Carotid Endarterectomy Trial (NASCET) & Audible Bleeding Landmark Papers NASCET Episode  Randomized trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) The 2nd European Carotid Surgery Trial (ECST-2): rationale and protocol for a randomized clinical trial comparing immediate revascularisation versus optimized medical therapy alone in patients with symptomatic and asymptomatic carotid stenosis at low to intermediate risk of stroke European Stroke Organisation (ESO) guideline on endarterectomy and stenting for carotid artery stenosis A comparative effectiveness study of carotid intervention for long-term stroke prevention in patients with severe asymptomatic stenosis from a large integrated health system SVS Patient Safety Organization (PSO) TCAR Surveillance Project SVS Vascular Quality Initiative (VQI) & VQI TCAR Registry Important recommendations of the German-Austrian S3 guidelines on the management of extracranial carotid artery stenosis (Paper only available in German)  Hosts: Laurence Bertrand is a 5th-year vascular surgery resident at the Ludwig Maximilian University Hospitals of Munich, Germany.  She is a medical graduate from KULeuven, Belgium, and has a Master of Science in International Health from the London School of Hygiene and Tropical Medicine.    Ezra Schwartz (@EzraSchwartz10) is a medical graduate from McGill University pursuing a Master of Medical Science in Medical Education at Harvard Medical School. He is applying to integrated vascular residency programs this year.  Please share your feedback through our Listener Survey! Follow us on Twitter (@audiblebleeding) and learn more about us at https://www.audiblebleeding.com/about-1/.  

Carotid stents, the paclitaxel story now closed, inclisiran, DOAC failures, and primary vs secondary prevention are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Carotid Stenting CMS Proposal Expanded Coverage of Carotid Stenting in CMS Draft Proposal https://www.medscape.com/viewarticle/994315 No Added Benefit From Revascularization in Low-Risk CAS https://www.medscape.com/viewarticle/992524 - Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&NCAId=311 - Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy https://doi.org/10.1016/S0140-6736(21)01910-3 - SPACE-2 https://journals.sagepub.com/doi/10.1177/1747493019833017 - Rationale, Design, and Implementation of Intensive Risk Factor Treatment in the CREST2 Trial 10.1161/STROKEAHA.120.030730 II. Paclitaxel FDA: No Excess Mortality Risk From Paclitaxel Stents, Balloons for Peripheral Intervention https://www.medscape.com/viewarticle/994253 - FDA Statement https://www.fda.gov/medical-devices/letters-health-care-providers/update-paclitaxel-coated-devices-treat-peripheral-arterial-disease-unlikely-increase-risk-mortality?utm_medium=email&utm_source=govdelivery#_FDA_Actions III. Inclisiran FDA Expands Inclisiran Statin-Adjunct Indication to Include Primary Prevention https://www.medscape.com/viewarticle/994185 - ORION 10-11 Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol https://www.nejm.org/doi/10.1056/NEJMoa1912387 - Effect of inclisiran on lipids in primary prevention: the ORION-11 trial https://doi.org/10.1093/eurheartj/ehac615 - Inclisiran and cardiovascular events: a patient-level analysis of phase III trials https://pubmed.ncbi.nlm.nih.gov/36331326/ IV. DOAC Failure Association of Alternative Anticoagulation Strategies and Outcomes in Patients With Ischemic Stroke While Taking a Direct Oral Anticoagulant https://doi.org/10.1212/WNL.0000000000207422 V. Primary or Secondary Prevention You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Getting diagnosed with a constriction or blockage in the arteries that supply blood to your brain can be quite daunting, as Nancy from South Carolina can confirm. She discovered she had carotid artery disease,which put her in danger of having a stroke. The carotid arteries, one on each side of the neck, are crucial blood vessels that provide blood to the brain, neck, and face. About one-third of all stroke cases are associated with diseased carotids. This disease arises when fatty residues, known as plaque, accumulate in these arteries. Alarmingly, in its initial stages, this disease often goes unnoticed due to a lack of symptoms. It only becomes noticeable when it becomes severe enough to deprive the brain of oxygen, resulting in a stroke or a transient ischemic attack (TIA). Lucky for Nancy, she discovered her condition early as she was under close observation following a heart attack. During a routine medical examination, a Physician Assistant detected a bruit, a turbulent flow in her neck arteries, using a stethoscope. In today's episode, Nancy shares her journey from diagnosis to receiving advanced treatment. Also joining us is the globally recognized Interventional Cardiologist Dr. Ehrin Armstrong, who discusses treatment guidelines and ongoing debates that could alter how and when doctors can offer more than just medication to enhance blood flow and avoid severe complications.