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Melanie Cole (Host): A new post-anesthetic care unit and hybrid operating suite recently established at Our Lady of Lourdes Medical Center is enhancing Lourdes neurosurgical and cardiovascular surgery capabilities. The new facility combines the advanced imaging capabilities of cardiac catheterization laboratory with the environment of a traditional operating room. My guest today is, Dr. Erol Veznedaroglu, he’s an internationally renowned neurosurgeon who leads Global Neurosciences Institute. Lourdes health system has an expanded partnership with Global Neurosciences Institute creating a comprehensive hub for neurosurgery in South Jersey. Welcome to the show, Dr. Vez, so tell us about this new hybrid lab at Lourdes, and what is it intended to do?

Dr. Erol Veznedaroglu (Guest): Sure, Melanie, it’s actually an amazing new setup, and it’s really it’s what we’re seeing in medicine today where the equipment that we use is actually catching up to older mechanisms and hospitals. So, 10 years ago, maybe even five years ago, most of any type of neurosurgical work was done in a traditional operating room, where we had to open someone’s skull and do what most people think about, when they think, brain surgery. But today, we’re doing more and more work from an endovascular standpoint, we go through the groin, like the cardiologist started to do for cardiac catheterization, and we can now go directly up into the brain, but for acute emergencies, where someone has a hemorrhage or bleed in their brain from a ruptured aneurysm. Many times we have to convert to an open procedure, and what that means for the patient is lost time, and time is brain.

So, if we get to a traditional interventional suite, and we start taking our pictures and we see we have to go to an operating room immediately that patient has to be taken off the table, taken to sometimes a different part of the hospital, re-setup from an anesthetic standpoint. With this, we can push a button, and literally within several minutes, we’ve converted a traditional interventional suite into a high-tech operating room where we can start to do open brain surgery. And It’s really literally saving time and lives.

Melanie: That’s so cool. So, it can be transformed for conventional surgery if that need arises, without transporting patients, you can just bring in a different team of specialists. Now, tell us about the advanced diagnostics and the procedures that can be performed in this new facility.

Dr. Veznedaroglu: So, several, and one of the kind of new…the revolution in treatment of stroke, right now, is actually stroke is now a surgical procedure. Several years ago, there really wasn’t much we could do by the time the patient had a stroke the damage was done. Now, we’re able to intervene very…in an acute fashion, and the patients get brought almost like a trauma, emergently to this interventional suite, and we can actually go up and remove the blood clot that’s lodged in an artery, that’s inhibiting blood flow to the brain.

And there’s new stent retrievers, new devices, actually we’re the principle investigator of the largest prospective trial in the world, right now, it’s called the Trevo trial, looking at different devices to help open up these clogged arteries. And the imaging that you can imagine, we’re talking about, sometimes two and three-millimeter artery vessels, that we can see…we can magnify it, we can do 3D reconstructions. So, it’s not only the diagnostic and the precision, but it becomes a much safer procedure because we can see exactly what we’re doing and not harm vessels.

Melanie: So, for these endovascular procedures, like you’re discussing, clot removal, aneurysm repair, any of these things can be done right there, and as you say, “Time is brain.” So, speak a little bit about the expanded partnership with the Global Neurosciences Institute, and how did that come about.

Dr. Veznedaroglu: So, it came about…we’ve been servicing the Southern New Jersey area for quite a while, we used to be at Jefferson, and we develop Global Neuroscience Institute to be able to deliver the highest level of care to hospitals like Lourdes, which is a world-class institution, has some of the highest metrics for cardiac care, and has been a leading healthcare provider in the region for a long time, and this allows them to be able to adequately serve the patient population without having a one-sided affiliation, like many of the larger universities have with some of the smaller hospital systems.

So, to give you an example, we’re doing several things there now that no-one in the mid-Atlantics doing. One of the procedures we’re doing in that room is, we’re able to treat brain tumors now by delivering chemotherapy directly to the brain tumor through a small catheter, and before this technology was available, we really weren’t able to safely do this. So, when someone has a malignant brain tumor, our traditional mode of treatment is giving chemotherapy, radiation, which, for the most part, doesn’t mark, and whether you’re at Harvard or MD Anderson, it’s the same standard protocol.

So, we’ve kind of thought a little bit outside the box, and we can deliver the chemotherapy directly to the brain tumor, we can deliver it less invasively through a small catheter through the artery in the groin, go all the way up, see the arterial supply to the brain tumor, and inject the chemotherapy. And Lourdes is the one of the only places in the mid-Atlantic doing that, and we’re the only doctors in the Philadelphia region doing that.

Melanie: At the heart of the new lab is the biplane angiography system, speak about that, tell the listeners what that is.

Dr. Veznedaroglu: So, what that is, is it allows us to visualize areas of the brain that we couldn’t visualize before. The technology has gotten such that we can access a millimeter vessel distantly in the brain that we barely could see in an operating room, let alone in an angiography suite. So, the biplane allows us to have 3D visualization of all of the blood vessels, and actually the brain tissue itself. So, we can actually perform a CAT scan on the table, as well as look at all the blood supply, and that allows us to either repair a vessel, dislodge a vessel that has a clot in it from someone that’s having an acute stroke, or repair a ruptured aneurysm.

Melanie: So, Dr. Vez, are there certain people who are using this? Is it still in production? Is it being used right now? What’s going on as it’s state right now?

Dr. Veznedaroglu: Well, this has become, like many things in medicine, this will become the standard of care. Many people have biplane angiography, and that’s something that is almost standard now for doing any type of procedures in the brain, but what’s very novel is having this type of equipment in a traditional operating room. 10 years ago, and even now, it’s not that common where neurosurgeons do both the endovascular procedures as well as the open, and as that becomes more and more common, the tools for a neurosurgeon, which all of us are, are an operating room and an endovascular suite. So, that we can do everything as needed quickly and efficiently, and we have all the tools at our disposal. We don’t have to pick up the phone and call in another specialist to come in on the back end of an emerging case.

Melanie: And you did a YouTube tour of the new hybrid lab, tell us about that a little bit.

Dr. Veznedaroglu: So, and that’s really…the visualization is key. To be able to actually see the equipment, and so, what we’re able to do is bring a camera crew into the suite, so that the viewers could actually envision what…first of all, the scope of this, the size of this room. The imaging modality, to be able to actually…on that YouTube video, you can see basil artery aneurysm, which is an aneurysm that had a 70% mortality with surgery not that long ago. It’s such a dangerous aneurysm because it was very difficult to approach, which is now routine treatment on this type of equipment, and actually you can see that aneurysm. This big blister in someone’s brain, and you can see how we have a 3D reconstruction, we can rotate it around, look at it from the inside. It really is remarkable.

Melanie: And Lourdes health system has the stroke gold plus achievement award with Target and The Stroke Honor Role, by the American Heart Association, and the American Stroke Association. So, now this will just expand that ability, yes?

Dr. Veznedaroglu: Absolutely, absolutely, and as well for other types of cerebral vascular emergencies and care, including aneurysms, narrowing of the arteries, the carotid arteries in the neck, and other areas in the brain. I think we’re catching up to where they are with cardiology, which is a pretty big achievement and a pretty big task to do, but we’re getting there.

Melanie: So, in summary, Dr. Vez, wrap it up for us. What you want the listeners to know about this exciting new hybrid lab at Lourdes.

Dr. Veznedaroglu: Basically, that this cutting-edge technology, but more importantly, the doctors that are using it are the most experienced in the region. There’s no more experienced team in the Philadelphia or New Jersey region. There’s five dual-trained, fellowship trained, cerebral vascular, endovascular neurosurgeons that are there all the time doing the most complex of cases, and also doing things where patients are being referred from around the county, and actually around the world. Three months ago, a patient from Australia, flew here for treatment.

Melanie: Wow, how exciting and congratulations on all the great work that you’re doing. Thank you for being with us today, you’re listening to Lourdes Health Talk, and for more information, you can go to, LourdesNET.org, that’s LourdesNET.org. This is Melanie Cole, thanks so much for listening.