Improving Outcomes with Neuro Interventional Radiology

Author: Jeffrey Thomas, MD; Jack C. Rose, MD
Specialty: Neurosurgery

According to the Centers for Disease Control, cerebrovascular disease is the fifth leading cause of death and one of the leading causes of disability in the United States. For the 7 million adults who have suffered these conditions, the effects can be life-changing and long-lasting.

However, with advances in response time and care, outcomes are improving all the time. Regional stroke centers, like ours at Washington Hospital, and life-saving treatment, like minimally invasive neuro interventional radiology (neuro IR) procedures, are helping make these types of cerebrovascular events more survivable than ever.

What is cerebrovascular disease?

Cerebrovascular disease refers to a group of conditions that affect veins or arteries and blood supply within the brain (cerebro- referring to the cerebrum or brain and -vascular relating to blood vessels) that can permanently damage it.

In stroke, 80-85 percent of cases are caused by a clot obstructing blood flow within the brain, called an ischemic stroke. This interrupted or reduced blood supply deprives sensitive brain tissue of oxygen and nutrients, causing brain cells to die within minutes. Transient ischemic attacks (caused by short-term vessel blockages or narrowing often called a stroke warning) are less common but disrupt people’s brain function similarly. Hemorrhagic strokes (bleeding within the brain or its fluid spaces) are also less frequent than ischemic strokes but are more life-threatening and typically cause abrupt severe headaches and even loss of, or altered consciousness. One dangerous but surgically treatable type of hemorrhagic stroke (called subarachnoid hemorrhage) is caused by a ruptured intracranial aneurysm. Aneurysm refers to a weakening of the vessel wall that causes a bulging or ballooning effect. As the vessel widens, its walls are stretched thinner and, like an overinflated balloon, eventually bursts, leading to internal bleeding. Although the term aneurysm isn’t specific to the brain, an intracranial aneurysm (aneurysm occurring intra- or within the crania- or skull) can rupture and cause hemorrhagic stroke. Occasionally brain aneurysms are discovered by imaging procedures and then treated before they rupture.

Why is response time and care so important?

First of all, it’s important to know that once brain cells die due to interrupted or reduced blood supply, they can’t be repaired. Even if the bleeding is stopped or the clot is removed, that damage is permanent. However, the brain is an incredibly resilient organ that can create detours and backdoors around damaged areas. This is why timing is so critical.

You can learn more about the importance of calling 911 from my colleague, neurologist Dr. Prabhjot Singh Khalsa, here.

As a designated Primary Stroke Center, the Stroke Program at Washington Hospital is one of the receiving centers for cerebrovascular events in Alameda County. Our team includes neurosurgeons, stroke neurologists, neurointensivists and nursing professionals who specialize in stroke management, and we work closely with emergency medical responders to ensure patients receive treatment as quickly as possible to reduce damage and complications.

Sometimes that means administering clot-dissolving drugs or taking a minimally invasive approach via neuro IR.

What is neuro IR and how does it help?

Neuro Interventional Radiology is a field of medicine that uses endovascular procedures (endo- meaning “within” and -vascular, again, relating to blood vessels) to treat stroke and other illnesses. In this cath lab procedure, we use radiology to guide a catheter from a small incision in the groin through arteries to the affected area – in this case, the brain – with the goal of restoring blood flow and minimizing damage.

For ischemic stroke, we navigate the catheter to the site of the blockage and deliver clot dissolving medication (such as tissue plasminogen activator or t-PA) or microsurgically remove the clot (mechanical thrombectomy).

For aneurysm, we use microsurgical clipping, coil embolization or a combination of the two to stop bleeding and/or isolate the affected area. Like Dr. Thomas said, clipping, though not a neuro IR procedure, involves carefully tracing the parent blood vessel to the aneurysm and applying a titanium clip to exclude it from normal circulation, while coil embolization uses a catheter to deposit platinum microcoils into the aneurysm that promote clotting, normalizing blood flow.

Not only does Washington Hospital have one of the few neurosurgeons (Dr. Jeffrey Thomas), in the U.S. who regularly does both endovascular and microsurgical treatments in the case of complex cerebrovascular conditions, he can perform both techniques on the same patient.

In conditions where minutes matter, our comprehensive approach to diagnosing and treating both ischemic stroke and ruptured brain aneurysms – built around fast response, collaboration, continuity of care, and support – we’re able to offer interventions that give patients the best possible chance for, not just recovery but also, life.

Posted July, 2018