Source: CCTV.com

08-07-2006 13:40

Caption: November 2005: Doctors at No. 2 Hospital attached to Shaanxi Textile Administration prepare for the hospital's first-ever carotid endarterectomy.

In China every year:

1,000,000 people are disabled by a stroke

Every 3 minutes:

1 person will be killed by a stroke

Every 12 seconds:

Someone suffers a stroke

1. Across China, millions of people are dealing, either personally or by caring for a loved one, with the aftereffects of a stroke, and with the physical and emotional damage a stroke can cause.

2. So enormous is the amount of money spent by Chinese people every year on stroke-related medical costs and disabilities, that it could cover the entire amount spent by the Beijing Government on the infrastructure for the 2008 Olympic Games!

3. A carotid endarterectomy is a surgical procedure to treat stroke. The aim is to remove harmful plaque from the carotid arteries, the two vital routes, one on each side of the neck, for supplying blood and oxygen to the brain. A build-up of plaque in the carotid arteries is a major cause of strokes.

4. The onset of a stroke is often signalled by nothing more than a headache; in fact, sufferers may be completely unaware of anything amiss. In other cases, however, the effects can be devastating.

Caption: 9:00 am: Operating theatre

5. Wang Zhen is from Xi'an in Shaanxi Province. He is married, and has a child. He works as a playwright. It's a job he loves, and he is the creator of many popular works. As a man who was happy both with his career and at home, he was leading a seemingly idyllic life. Until one day ….

6. Without any warning, while he was working on a script, he simply collapsed. He was rushed to hospital, where he was diagnosed as having suffered a stroke.

7. Zhang Qinyi, a leading cardiovascular surgeon, is the head of the team performing CEA operations at the No. 2 Hospital attached to Shaanxi Textile Administration. In coping with strokes, it's of vital importance to recognise the warning signs, and take preventive medical action before a stroke occurs. Zhang Qinyi, is a long-standing proponent of this approach.

Interview:

Professor Zhang Qinyi

China District CEO of Sino-American Group for Strokes

In the case of bleeding, we have to open the skull in order to remove the clots. Or we can surgically unblock the veins. In thrombotic and embolic conditions, we dissolve the clots. When patients suffering from such conditions come to us for help, we treat the case as an emergency and prescribe fast-acting drugs to dissolve the clots quickly and leave the blood vessels unobstructed.

8. Blood in the arteries is responsible for carrying oxygen and nutrients to the brain. If there is a blockage in the arteries, the blood supply stops. Then what happens? A stroke.

9. A stroke can occur for two reasons. One, a blood vessel bursts and leaks blood into the brain tissue. This is called a hemorrhagic stroke. The second is an ischemic stroke, which is the most common. It occurs when a halt occurs in the blood flow in the head or neck.

10. Ischemic strokes can further be divided into two main types: thrombotic and embolic, depending on the actions of the blood clot, otherwise known as a thrombus. If the blood clot remains in place, it is thrombotic; if the clot becomes detached and travels, until it blocks a smaller artery, it is embolic.

Professor Zhang Qinyi

China District CEO of Sino-American Group for Strokes

Nearly a third of embolic strokes are caused by a narrowing of the carotids and the blood vessels in the skull. Most of the clots that lead to a blockage originate outside the skull.

It doesn't matter so much if the brain vessels in the skull are narrowed. Why? Because the vessels are small ones. However, if the brain vessels outside the skull are blocked, it will be very serious. The reason is that they are all big vessels, the blockage of which will affect the extremities a great deal. This is just like river flows. Take the Yangtze River as an example, if its main stream is blocked, the irrigation of the area along its lower reaches will be much affected. But, if only the branches of the Yangtze river are blocked, it won't be a serious matter.

11. A stroke occurs when a blood channel is blocked. It is just like the flow of a river being halted by rubbish. The narrower the channel becomes, the worse is the blockage, and thus the more probable it is that a stroke will occur. And CEA, or Carotid Endarterectomy, is a surgical technique to take out the rubbish, to widen the channel in an attempt to let the blood flow as smoothly as before.

Donald B Doty, M.D.

Department of Surgery, Education and Research, Intermountain Health Care

Carotid Endarterectomy means to remove the colossal plaque that blocks the artery that runs up to the brain in the neck.

Professor Zhang Qinyi

China District CEO of Sino-American Group for Strokes

It prevents strokes from happening. Of course, it is also therapeutic. If a blood vessel is 70% blocked by plaque, the blood stream will struggle to reach the extremities and the functioning of the organs will be affected. An operation to remove the blockage will allow the blood stream to flow normally. As long as they are not putrescent,the organs will resume functioning normally.

Doty: And it is very wide spread and practiced by vascular surgeons, neural surgeons, cardiovascular surgeons and so on.

12. This is how CEA is different from traditional treatments. It is more thorough and thus more effective.

13. Professor Zhang and his team have performed many CEAs, but mostly overseas. They are now spearheading a campaign to promote the technique within the country.

CAPTION: 10:00 am: Operating theatre

14. In Shaanxi Province, their first patient is Wang Zhen.

Wang Zhen：There's one thing I remember very clearly before I collapsed that day. You know I am a chain smoker. That day I was typing, a cigarette in my mouth. But the cigarette kept swinging back and forth in front of my eyes. I was curious, so I put the cigarette in the ashtray and placed another one in my mouth. But this, too, kept swinging. The doctor later told me it was caused by my face and mouth twitching.

15. The effects of a stroke depend on which part of the brain is damaged, and how severely. Therefore, different people may experience different warning signs. The most common indication of a stroke is a sudden sensation of weakness in the face, arm and leg, generally on just one side of the body. A sufferer may also experience difficulty with speaking, seeing and walking.

16. Traditional treatments focus on post-stroke recovery. But the results are often unsatisfactory, and can involve major – and potentially harmful – surgery.

Doty: Medicines of course are fine, but they don't really get out the problem, which is the block artery in the neck. It may make the blood a little thinner, so that it will go by a little easier. And can take care of some of the problems, but if the artery is really narrowed down, then there is nothing like an operation to get rid of that blockage.

Wang Zhen's Wife：

At first, they tried traditional therapy, cleaning and widening the blood vessels, and this lasted for over a fortnight. Later the doctors told me that he was alright, ready to leave

But the night after he left hospital, he felt very dizzy and uncomfortable.

Wang Zhen：

Later we learned that Professor Zhang Qinyi at the hospital could perform the operation. But when I went into hospital again, my family was very worried about the outcome.

17. Such worries are understandable. No operation is completely risk-free, and CEA is no exception.

Professor Zhang Qinyi

China District CEO of Sino-American Group for Strokes

The prime danger is bleeding. Operating on high-pressure blood vessels may cause local bleeding, serious enough to threaten the person's life.

A second danger is that the surrounding nerves may be damaged. and the third one is that the patient may suffer another stroke.

18. Such are the concerns about CEA that it took several decades before it became widely accepted in the US, where the technique was developed. Elsewhere, such as in China, the doubts still linger.

Douglas J Wirthlin, M.D.

Director of Vascular Surgery, Intermountain Health Care

In the United States, in the 50s, 60s and 70s, many of the doctors did not believe in CEA. Also there is a challenge of teaching the people, because the people may not know this treatment is available. People may be very afraid of surgery and someway it's easier just take a pill.

19. Understanding and accepting new knowledge and techniques can be a lengthy process. For example, today we take smallpox vaccine for granted, but back in the late 18th century when Edward Jenner first used cowpox as a vaccine against smallpox, people were horrified by the very idea of having a cow's disease injected into their body. Lacking a clear scientific explanation of the effects, vaccinations remained controversial throughout the nineteenth century. And Jenner himself became an object of ridicule.

20. Eventually, as we all know, the vaccine proved highly effective in protecting people from smallpox. It was globally adopted, and in 1980, the World Health Organization formally declared: "Smallpox is Dead!"

21. History often repeats itself. What happened to Jenner's vaccine may also be happening to CEA today. Traditional treatments for strokes, so many people believe, are not only effective but also much safer. They can see scant evidence that CEA does any good. Furthermore, they argue, it is, in fact, dangerous.

22. Fortunately, unlike in Jenner's day, science can provide us with statistical evidence. Studies by the North American Symptomatic CEA Trial have shown that the surgery is highly beneficial for people who have already suffered a stroke or experienced the warning signs, and have severe stenosis – or the narrowing of a blood vessel – of 70 to 99 percent.

Interview:

Doty: If carotid artery is narrowed greater than 70 percent, CEA is much better for those patients than just taking medicine. One of the risk of CEA is it can actually cause a stroke during the operation. But fortunately, the chance of causing a stroke is very low, especially after the surgeons have significant training.

Caption: Wang Zhen Undergoing CEA

23. In fact, CEA promises to bring a significant reduction in the incidence of strokes.

24. It's not only those who, like Wang Zhen, have already suffered a stroke, who can be helped by a CEA. The benefits are even greater for those people who are potentially at risk.

25. For example, there's Zhang Yunlan. In her case, the relatively simple CEA surgery can remove the danger of a stroke once and for all.

Interview:

Professor Zhang Qinyi

China District CEO of Sino-American Group for Strokes

This patient has severe plaque build-up

in his right carotid bifurcation.

It has led to stenosis

of the internal carotid artery.

This patient has potential danger. As we can see, there is a broken membrane with ulcer. The blood will easily form a whirlpool here, which will lead to embolism. If the clot travels to extremities, it will cause blockage of small arteries. A more serious thing is that, the membrane of the patient travels. The change of blood pressure may cause the tearing up of the membrane. If the membrane is torn up completely, the vessel will be entirely blocked. This is potentially very dangerous.

The plaque is big. If a clot is formed around the plaque, it will block the vessels entirely, after which the blood flow will be blocked, leading to serious deformity or even death.

26. Zhang Yunlan is fortunate, in that the doctors have decided a CEA will be effective in her case. Had her condition been much worse, the doctors would have decided a CEA would be too dangerous to attempt.

Interview:

Professor Qu Genxue

Cardiovascular Surgery of the Number One Hospital of Xi'an Jiaotong University

This is a DSA image of the head and neck.

The carotid artery, and internal and external arteries, are normal,

with no signs of stenosis or plaque.

This is a normal image.

This is a second DSA.

There is plaque and stenosis in the upper three arteries.

Stenosis is evident in the carotid bifurcation.

This is an evident diagnosis. He should try CEA or CAS operation.

Now let's look at the third one.

The right internal artery is occlusive,with no contrast or blood flow.

Given his condition, this patient is not a candidate for CEA or CAS.

27. If all goes well, Zhang Yunlan can expect to leave hospital the day following the operation. Her condition will be monitored for a month.

Caption: Wang Zhen's CEA reaches the critical phase

28. The doctors are preparing to open Wang Zhen's carotid artery, in order to find the plaque that is the main cause of his condition.

29. Having identified the position of the plaque, they are trying to remove it. All the time, they are guarding against damaging the artery wall.

Interview:

Professor Zhang Qinyi

China District CEO of Sino-American Group for Strokes

The plaque is formed of cholesterol that has been deposited in the blood vessel.

The primary cause of such deposits is over-eating.

For example, overweight people eat too much high-calorie food.

Regular smokers,people with high blood pressure,and those with hyperglycemia and hypertension run the highest risk of suffering a stroke.

30. The operation has been completed. But it does not necessarily mean it's been a success. The first 12 hours after surgery are critical.

Caption: Wang Zhen on the road to recovery

31. Although he is conducting more and more successful CEA operations, Zhang Qinyi knows there is a long way to go before the technique is widely adopted across China. For one thing, the cost, including diagnostic tests, surgical procedure and post-operative care, is prohibitively high for most patients. For another, more surgeons need to be trained, to perform the operation.

32. Still, there have already been many beneficiaries of CEA. With time, there is a growing awareness that not only individuals but society as a whole, stand to benefit.

 

Editor:Ge Ting