Neurosurgeons Use Angioplasty to Give Golfer Back her Swing

Most people are familiar with angioplasty, a procedure where a small balloon pushes open an artery in the heart to clear a blockage, but neurosurgeons have only recently began to investigate its effectiveness in opening arteries to the brain. UNM neurosurgeons recently performed a vertebral artery angioplasty on arteries leading to the brain with stunningly successful results that helped a lifelong golfer get back to the life she loves.

One could say that golf has ruled Sandra Ashley's adult life beginning 35 years ago when she took a job in a pro shop that led to meeting her husband. The two have played golf ever since. Their love of golf led to them playing throughout the United States. Today she is the manager in the UNM North Campus Pro Golf Course and teaches formally and informally through the shop.

A stroke in June of 2005 changed that. The stroke affected her coordination to the extent that she couldn't play or go to work or teach golf. "Golf is all about balance. You have to be able to look down to teach," said Ashley, who is an LPGA certified instructor. "But after the stroke, I couldn't move my neck, couldn't look down or bend down. My right hand was ok but the left hand wasn't. I was dizzy whenever I moved my head."

The carotid arteries in the neck are the main source of blood supply to the brain and a common site of blockage due to atherosclerotic disease. However, Ms. Ashley was found to have severe disease in the vertebral arteries causing her symptoms. The vertebral arteries are the arteries in the neck that supply blood to the base of the brain and brainstem. Like the blood vessels of the heart, the vertebral arteries can also develop a build-up of fat and cholesterol deposits. Over time, the build-up narrows the artery, decreases blood flow to the brain and can lead to a stroke. Blockages within the vertebralarteries are a major risk factor for ischemic stroke, the most common form of stroke.

While surgery is an option for some patients with blocked arteries supplying the brain, another piece of the puzzle made Ashley's case even more challenging. Most people have to two vertebral arteries, each running parallel alongside the spine to the brain. Ashley has one vertebral artery, severely narrowed by the buildup or atherosclerotic plaque. The second artery has already been closed completely by her disease. The couple began a round of looking for physicians that ended at UNM with a referral to Howard Yonas, M.D., chair of the Department of Neurosurgery. He told them of the recent arrival of Christopher Taylor, M.D. and his expertise in using a new technique that is less invasive than traditional surgery.

An endarterectomy, the standard surgical treatment for carotid artery disease, is much more difficult for the vertebral arteries and would have required that she be under general anesthesia. With the angioplasty procedure, Ashley was awake throughout her 2.5 hour surgery. "They had me doing mathematics," she said. "They wanted to be able to know immediately if something wasn't going the way they planned."

A long, thin tube called a catheter was inserted through a small puncture site over a groin artery and guided through the blood vessels to the vertebral artery. A tiny balloon within the catheter was then inflated to flatten the plaque against the walls of the artery and then a tiny metal mesh tube called a stent was placed in the artery to hold it open.

Within hours she was feeling better. Within a couple of weeks she was out on the course and found "the swing was still there. I was making 25 footers. Things seemed better than new."

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Contact: Cindy Foster, 272-3322

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