A still relatively unknown diagnostic procedure available at Lakes Region General Hospital may help identify persons most at risk for one of the more common types of stroke.

Known as a carotid ultrasound, the test detects fatty plaque buildup in the carotid arteries on both sides of the neck. When blood flow to the brain is blocked, a stroke occurs and brain tissue is damaged.

It is estimated that carotid strokes are responsible for one-third or more of all strokes, said Dr. Glenn Fusonie, a vascular surgeon and member of Lakes Region Vascular and Endovascular Surgery, a department within LRGH.

“The carotid artery ultrasound looks at the images of the artery and the blood flow through the artery and that gives us information about whether that artery is diseased or not,” Fusonie explained. “This is a non-invasive test that is very reliable in determining if there are significant narrowings in the artery.”

Carotid ultrasound testing “has been around for some time,” he added, but only now is it becoming “universally accepted” as a screening mechanism.

Along with old and new surgical procedures, the carotid ultrasound is increasingly helping doctors prevent strokes in some patients, while post-stroke therapies are helping put victims back on their feet, literally, as soon as possible.

The American Heart Association says that stroke is the leading cause of disability in the U.S. and the third most common cause of death behind heart attacks and cancer.

To prevent a stroke, the AHA recommends that people exercise regularly, control their blood pressure, not smoke, and cut down on foods that are high in cholesterol, fat, and sugar.

But when prevention alone is not enough, early detection and intervention are key, and for those persons who do suffer strokes, LRGH, as well as many other medical centers in New Hampshire, offer a variety of rehabilitative therapies.

Each person’s stroke is different and the resulting complications are similarly different, said Stephen Fusco, an occupational therapist and director for rehabilitation at LRGHealthcare, the corporate parent of both LRGH and Franklin Regional Hospital.

Although therapies vary in treating stroke victims, the goal, he said, is the same: to get people up and moving and, in that way, back to health more quickly.

At LRGHealthcare, said Fusco, “we do an aquatic therapy program with our patients” to facilitate movement in a safe, controlled environment in which the patient can exercise more vigorously because the person’s weight is offset by the buoyancy of the water.

That same philosophy takes a different form at Healthsouth Rehabilitation Hospital in Concord, according to Wendy Guillette, the stroke program manager there.

Utilizing an “unweighing device” - a harness that features a pressurized weight-control system - a therapist can gradually “unload” up to 150 pounds of a patient’s weight and then gradually reintroduce it as the patient’s strength and motor control improve.

“They say the faster you move, the quicker you become stronger and recuperate, which is certainly true for any muscle rehabilitation,” said Fusco.

Fusonie pointed out that, in addition to detecting blockages in the carotid arteries, the ultrasound device can be used to look for problems elsewhere within the circulatory system.

“A large percentage of strokes are connected to having diseases of the carotid arteries, but another pathology that we are very concerned about is aneurysmal disease which means that certain arteries can get large and dilated to the extent that they can rupture and the area where we’ve focused in on that is the abdominal aorta, the main artery in the abdomen,” said Fusonie.

A sonologist can check for vascular diseases such as an abdominal aortic aneurysm, or what Fusonie called “the triple A.”

When an abdominal aortic aneurysm is diagnosed, Fusonie and his Lakes Region Vascular and Endovascular Surgery colleagues can treat it in one of two ways.

The tried-and-tested surgical procedure for a “triple A” involves an incision from the pubis to the breastbone.

But for a selected patient population - mostly persons who are 60 or older and who have underlying medical conditions - a less-invasive option has become available over the last 10 years: the aortic stent graft operation. The vascular surgeons at LRGH are believed to be among only few in New Hampshire performing it.

With a small incision on both sides of the groin, the operation “is a big difference in terms of the incision,” said Fusonie, which means that the patient typically has less post-operative pain, is able to heal more rapidly, and can return to a normal life sooner than with the more open surgery.

“It was started in the 1990s,” Fusonie said of the aortic stent graft, “picked up steam in the late 90s, but we still don’t have long-term data about it. And when we look at the traditional open operation, we have long-term data and we know the longevity of that, but I’m optimistic about this procedure, too.

“It is a procedure that is very appropriate in the right people,” he added, noting that “the patient population happens to be the majority of people we see who have aneurysms who are typically older and have multiple medical problems.”

Younger, healthier people, ironically, may be advised to have the open operation, said Fusonie, “despite what their wishes may be,” because that surgery has proven successful in the long term and because they are physically better able to recover from it.

Overall, Fusonie continued, “we’re very fortunate that LRGH offers these medical modalities in this area” - the carotid ultrasound and the aortic stent graft operation - to ensure that more people have a positive outcome from what could be potentially life-threatening diseases.

Combining those resources at LRGH with the use of angioplasty and stenting for blocked peripheral arteries, “we now have offered in this community some less-invasive ways of managing some pretty big vascular problems,” said Fusonie.