Improving Outcomes with Neuro Interventional Radiology
Jeffrey Thomas, MD;
Jack C. Rose, MD
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
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,
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