Miller School Student Leads Review of Concurrent Carotid Stenosis Surgeries

Article Summary
  • Miller School of Medicine student Julia Telischi was first author on a published review of literature discussing the viability of concurrent surgeries for cancer patients who develop carotid stenosis.
  • The review was inspired by a University of Miami Health System patient who tolerated concurrent surgeries for cancer and carotid stenosis.
  • Telischi and the research team hope their work encourages physicians to consider the option.

A published review led by a University of Miami Miller School of Medicine student posits that the two separate surgical procedures often performed for cancer patients who develop carotid stenosis can be done simultaneously in some instances.

“Patients with head and neck cancers often require surgical intervention in the neck, near the carotid artery,” said first author Julia Telischi, Miller School Class of 2025. “For example, ENTs (ear, nose and throat specialists) may conduct a neck dissection to reach the patient’s lymph nodes. This presents an opportunity to bring in vascular surgeons to treat the stenosis with a carotid endarterectomy during the same procedure. One surgery instead of two.”

Miller School of Medicine student Julia Telischi
Miller School of Medicine student Julia Telischi was first author of a published review analyzing concurrent surgeries for carotid stenosis and head and neck cancer.

Telischi notes many patients with head and neck cancers are at risk for the narrowing of the carotid artery due to plaque that characterizes carotid stenosis. Stenosis is also a known side effect of the radiotherapy used to treat cancer. During a carotid endarterectomy, surgeons open the vessel and physically remove the plaque.

Conducting the procedures that target cancer and stenosis concurrently alleviates the need to choose which one has precedence. It also may mitigate some risks of worsening stenosis from post-surgical radiation therapy.

Review Prompted by UHealth Patient

The review, published in Current Opinion in Otolaryngology & Head and Neck Surgery, was motivated by a UHealth—University of Miami Health System patient with carotid stenosis who needed surgery for his cancer. The ENT and vascular teams worked simultaneously. It was a delicate procedure, but the patient tolerated it well.

In the paper Telischi, resident Eric Niesenbaum, M.D., and senior author Elizabeth Nicolli, M.D., assistant professor of otolaryngology at the Miller School, examined the existing literature on simultaneously conducting these procedures. The data was sparse but encouraging.

A masked female surgeon working in the operating room
Telischi and the research team hope their review leads to larger studies involving concurrent cancer and stenosis surgeries.

“These joint procedures have been done a few times, but have not been extensively reported in the literature,” said Telischi. “However, in the cases we did find, it was a safe technique with few adverse events or strokes following surgery.”

Challenges and Opportunities

The authors note simultaneous procedures pose challenges. Both surgical teams must be available and some patients may not tolerate longer surgeries. Concurrent procedures should only be recommended for patients with the greatest risk from stenosis.

Ultimately, Telischi and team hope this research encourages otolaryngologists and vascular surgeons to consider the approach.

“It looks quite promising,” said Telischi, “and we hope this paper opens the field to doing this procedure more often. People may also look into doing larger, more extensive studies on this approach to better show the effect on patient outcomes.”

Tags: head and neck cancers