FAYETTEVILLE—In just the past year, minimally invasive endovascular neurosurgery for strokes and other cerebrovascular conditions has become the preferred standard of care. When treated in a timely manner, patients paralyzed on one side and\or unable to speak are often able to walk and talk within an hour. That is accomplished by using radiological imaging to guide a tiny catheter from an artery in the groin to the site to be treated. Clots can be removed without the risks and recovery time associated with open surgery.
Arkansas has the highest death rate from strokes of any state in the country. Mayshan Ghiassi, MD, and Mahan Ghiassi, MD, are two of only about 100 surgeons in the U.S. who are dual trained in both minimally invasive endovascular neurosurgery as well as conventional neurosurgery. When deciding where to practice after completing their residencies, they decided to come to Washington Regional because of the great need.
“The fact that the state is number one in stroke morbidity was a huge draw,” Mahan Ghiassi said. “We felt we could have more impact here than anywhere else in the country because Northwest Arkansas (NWA) was underserved. The change toward endovascular neurosurgery becoming the standard of care for strokes happened while we were going through our training, which was very exciting. NWA is a great location, not only because of the number of people who live in this area, but the surrounding population that has easy access to Washington Regional with air ambulance services.”
The brothers became co-directors of the Cerebrovascular and Endovascular Program at Washington Regional in August 2014.
“We are bringing a very new technology and therapy that is minimally invasive resulting in less risks to the patients and faster recovery times,” Mayshan Ghiassi said. “It is an exceptional time to be involved in stroke care because of the dramatic improvements possible with endovascular neurosurgical techniques. Patients who previously might have been in a nursing home the rest of their lives can instead recover quickly and have a normal life. Patients feel better and do better regarding long-term survival and functioning.”
The brothers said it is important for Arkansas physicians to know the intra-arterial /endovascular thrombectomy procedure gives acute ischemic stroke patients the option of the highest levels of care without the stress of traveling to Little Rock or Memphis. In addition to the benefits to the patient, the decreased costs to society from improved stroke care are tremendous. It is estimated that stroke care in Arkansas costs an estimated $300 million per year when taking into consideration direct care costs and indirect costs (i.e., loss of productivity and family leave). These new endovascular stroke therapies will significantly reduce length of hospitalization, reduce need for secondary procedures associated with debilitating strokes, decrease the proportion of severe disability after stroke and decrease loss of productivity of patients and their families.
“It makes sense not just medically to help someone live a normal life,” Mahan Ghiassi said. “But it also makes sense economically, something that insurance companies are recognizing. It is hard in medicine to find a new procedure like this that helps not just medically, but economically.”
The men were also attracted to Washington Regional because the hospital shared in their vision of bringing world-class stroke care to this underserved area of the country, which meant collaborating to build new facilities at Washington Regional, including a hybrid operating room (OR) that can be used for either open cerebrovascular or minimally invasive endovascular neurosurgery. If endovascular neurosurgery is used, but doesn’t completely clear up all the problems, the patient can be turned from the end of the table for endovascular surgery to the other end of the table designed for open neurosurgery. That prevents the need for a patient to be transported from one OR to another.
“The center also provides longer care instead of a patient having to be transferred to a long-term care facility,” Mahan said. “Patient care is not fragmented.”
In their first year, the Ghiassi brothers have seen even more patients than expected, especially stroke patients under the age of 40. While doing an interview for this article, they got a call and left to respond to a new 33-year-old female stroke patient. While it is difficult to know why there are so many young stroke patients in the state, they said it is probably linked to smoking, poor diet, obesity and lack of exercise, all of which can lead to high blood pressure that is less likely to be identified in younger patients.
Most of the endovascular surgeries require two neurosurgeons because of the delicate nature of the work. So the brothers work together almost every day. While they don’t read each other’s minds, they work well together.
“For the most part, I can pick up on what he is thinking,” Mahan said. “We are on the same page as far as the treatment processes.”
The Ghiassi brothers were born in Iran. The family, members of the Baha’i faith persecuted in the predominantly Muslim country, fled in 1985. They spent a year in a refugee camp in Pakistan before they were sponsored and brought to Nashville, Tenn., when Mahan was 5 and Mayshan was 7. That is where the family continued to live up until the brothers finished medical school, residencies and fellowships at the Vanderbilt University Medical Center. Their parents relocated with their sons, their wives, and their grandchildren. Mahan has three children, and Mayshan has one with another expected soon. As for their hobbies, right now their off duty world revolves primarily around spending time with their family.
