Conditions Treated and Services Offered

Aneurysms

An aneurysm forms when a weak area in blood vessel wall bulges out due to sustained pressure on vessel wall. Aneurysms can rupture and cause internal bleeding, which may have fatal consequences particularly for those aneurysms located inside the head. However, not all aneurysms rupture and not all aneurysms need treatment. An aneurysm can be treated by open neurosurgery or by minimally invasive endovascular techniques, such as through endosaccular embolization using detachable platinum coils or by placement of a flow-diverter stent in the involved arterial section.

Photo of Basilar aneurysm pre

Basilar tip aneurysm before treatment

Photo of Basilar aneurysm post

Basilar tip aneurysm treated with stent assisted coiling

 

 

 

 

 

 

 

 

 

Brain Arteriovenous Malformations (Brain AVMs)

AVMs are abnormalities of the arteries and veins in which a direct connection, or short circuit, exists between the arteries and veins. Most AVMs are congenital i.e. the abnormal direct connection was present at birth. This abnormal tangle of vessels connecting the arteries and veins can grow with age and cause symptoms of headache, seizures, or bleeding which usually do not appear until the 3rd or 4th decade of life. Rarely infants or small children are also found to have an AVM. Surgery, radiation, and endovascular treatment are complementary techniques used for the treatment of these lesions. Neurointerventional techniques can be used to block these abnormal vessels using glue like materials (Onyx, NBCA etc.) injected through catheters (tubes) introduced into the blood vessels feeding the malformation.

Carotid Cavernous Fistulas (CCFs)

CCFs are an uncommon but unique subgroup of vascular malformation. Most are acquired later in life than AVMs. They can be separated into direct connections between the carotid artery and the veins of the cavernous sinus (usually due to trauma) or indirect connections in which small arterial branches supply the veins. Both types can be treated very effectively with different endovascular devices.

Carotid Stenosis

Carotid stenosis is a progressive narrowing of the carotid arteries in a process called atherosclerosis. Normal healthy arteries are flexible and have smooth inner walls. As we age, hypertension and small injuries to the blood vessel wall can allow plaque to build up. Plaque is a sticky substance made of fat, cholesterol, calcium, and other fibrous material. Over time, plaque deposits inside the inner wall of the artery can form a large mass that narrows the lumen, the inside diameter of the artery. Atherosclerosis also causes arteries to become rigid, a process often referred to as “hardening of the arteries.” For some patients, carotid artery stenting may be an alternative to open surgical repair of the artery.

Photo of Before Stent Placement

Before Stent Placement

Photo of After Carotid Stent Placement

After Carotid Stent Placement

Cerebrovascular Stenosis

Atherosclerotic disease or hardening of the arteries can cause severe narrowing (stenosis) of the arteries of the neck and brain. Sometimes this arterial narrowing may result in a stroke (permanent damage to the brain from lack of blood supply) or temporary symptoms of a stroke. This can be from the particles of blood clot or the atherosclerotic plaque breaking free from the narrowing or from a reduction in the flow through the narrowed vessel. Neurointerventional techniques can be used to dilate and open a narrow vessel using balloon devices and/or by placing delicate metallic tubes (called stents) to help keep the vessel open.

Pseudotumor Cerebri Syndrome

The fluid that surrounds the spinal cord and brain is called cerebrospinal fluid or CSF. Cerebrospinal fluid supplies the brain and spinal cord with nutrients and removes impurities while protecting and cushioning these delicate structures. Normally, CSF is reabsorbed into the body through blood vessels. But if too much fluid is produced or not enough is re-absorbed, the CSF can build up and cause pressure within the skull. This pressure can cause symptoms similar to those of a brain tumor, including headaches and vision problems. Untreated pseudotumor cerebri can result in permanent problems such as vision loss. Placement of a stent in the draining venous sinuses to improve CSF absorption and reduce intracranial pressure is an appropriate treatment alternative to placement of a shunt, for some patients.

Image of narrowing in the veins before treament

Narrowing in the veins before treatment

Image of narrowing after stent placement

Resolution of narrowing after stent placement

 

 

 

 

 

 

 

 

Stroke

Most strokes are caused by blood clots lodging in the arteries of the brain. These blood clots can come from the heart or from atherosclerotic plaque in the vessels anywhere from the heart to the brain. If the blood clot blocks the artery for a period of time, the brain cells ordinarily supplied by that artery will die from lack of oxygen and nutrients. In some patients, the clot can be removed using modern clot-retrieval devices, such as stent retrievers or clot aspiration catheters, and/or with clot-dissolving (fibrinolytic) drugs delivered through tiny catheters to the specific occlusion site.

Tumors

Some patients with tumors of the brain or spine undergo embolization before surgery. Embolization refers to blockage of arterial supply using small particles through a small catheter (tube). This procedure referred to as pre-operative embolization reduces blood loss during surgery, makes surgery safer and faster, and thus potentially allows a more complete removal of the tumor.

Vasospasm

When an aneurysm ruptures, the bleeding over the surface of the brain sets in to motion a cascade of chemical events that result in severe narrowing of the arteries of the brain several days after the rupture. This narrowing may be so severe that medical treatment to keep enough flow through the vessel may fail. In these patients, neurointerventional techniques are employed to open the affected arteries either by direct administration of drugs and by using balloon devices to dilate the narrow arterial segments.

Spinal Vascular Malformations

Arteriovenous malformations (AVMs) and vascular tumors often involve the spine or spinal cord as well. Neurointerventional techniques are frequently used to diagnose these abnormalities and serve as an adjunctive treatment tool.

Vascular Malformations

Vascular malformations can occur anywhere in the body. They include abnormalities of the veins, lymph vessels, both veins and lymph vessels or both arteries and veins. These anomalies include venous malformations, lymphatic malformations and arteriovenous malformations. Venous and lymphatic malformations may cause a lump under the skin. There may be an overlying birthmark on the skin. Bleeding or lymph fluid leaking may occur from skin lesions. Arteriovenous malformations may cause pain. They are also more stressful on the heart because of the rapid shunting of blood from arteries to veins. Treatment for vascular malformations depends on the type of the malformation. Each type of malformation is treated differently. Laser therapy is usually effective for capillary malformations or port wine stains, which tend to be flat, violet or red patches on the face. Arterial malformations are often treated by embolization (blood flow into malformation is blocked by injecting material near the lesion). Venous malformations and lymphatic malformations are usually treated by direct injection of a sclerosing (clotting) medication which causes clotting of the channels. There are surgical options for some lesions. Most often, a combination of these various treatments is used for effective management of the lesion.

Arteriovenous malformation of the neck treated with a combination of surgery, and sclerotherapy.

Image of Pre-Embolization

Pre-Embolization

Image of Post-Embolization

Post-Embolization

 

Venous sampling

This procedure is used to help diagnose and localize site of certain hormonal overproduction in the body.  Catheters are placed via femoral veins and are guided under X-ray visualization to the appropriate area in the body.  Blood samples are then collected to evaluate those sites for specific hormonal abnormalities. The test is usually performed for two conditions: Cushing’s disease and Hyperparathyroidism.

Image demonstrating catheterization for diagnosis of Cushing’s Disease.

Image demonstrating catheterization for diagnosis of Cushing’s Disease.

Image from a patient undergoing Inferior Petrosal Sinus Sampling procedure.

Image from a patient undergoing Inferior Petrosal Sinus Sampling procedure.

Image demonstrating catheterization for diagnosis of Cushing’s Disease.

Image demonstrating catheterization for diagnosis of Cushing’s Disease.

 

 

 

Wada testing

The goal of this is used to evaluate language and memory function before seizure surgery or tumor resection. An angiogram is performed to evaluate the arteries of brain before Wada testing to ensure safety. Specific medication is then injected into the right and/or left internal carotid artery, in order to put one side of the brain to temporary sleep. The patient undergoes neuropsychological testing that allows localization of speech and evaluation of memory function during this interval. The process is repeated on the other side of the brain.

Spine interventions including :

  • Vertebroplasty and vertebral augmentation with an implant
Photo of 1) 1) Compression fracture of lumbar spine 2) Treatment with "Spine Jack" to restore height 3) Injection of bone cement to stabilize fracture

1) Compression fracture of lumbar spine 2) Treatment with “Spine Jack” to restore height 3) Injection of bone cement to stabilize fracture

  • Treatment of Tarlov’s cysts
  • Pain interventions
  • Spine biopsy
  • Radiofrequency tumor ablation

 

Other conditions treated by Neurointerventional radiology and Services offered:
Acute Hemorrhagic Stroke; Acute Ischemic Stroke; Aneurysms Treatment and Surveillance Program, Arteriovenous Malformation and Fistulas, Birthmarks – Pediatric Vascular Malformations; Vascular Lesions of the Head and Neck; Pre-surgical Devascularization of Brain, Head, Neck, and Spine tumors; Carotid atherosclerotic disease; Cushing Syndrome – Inferior etrosal Sinus sampling; Epistaxis; Intracranial atherosclerotic disease (ICAD); Moyamoya Disease; Pulsatile Tinnitus; Pseudotumor Cerebri – Venous Sinus Stenting; Retinoblastoma; Seizures – WADA testing; Spinal AVMs and Spinal dural AVFs; Kyphoplasty and Vertebroplasty for Compression Fractures and Spine Associated Pain; Spine Biopsy; Tarlov Cyst Injection; Spinal angiogram; Soft tissue biopsy; Lymph node biopsy