Neuroendovascular Treatment 

Minimally Invasive Treatment for Cerebrovascular Diseases 

Abington Memorial Hospital specialists provide advanced minimally invasive, surgical treatments for cerebrovascular diseases such as strokes or aneurysms. Abington Hospital's comprehensive endovascular treatments are available around the clock.

The full range of endovascular treatments performed by the neurosciences team including neurosurgeons and neurointerventionalists include:

• Stents and/or balloon assisted coil embolization
• Intra-arterial thrombolytic therapy
• Mechanical removal of the intravascular clot
• Carotid artery stent placement
• Intracranial stent placement
• Particle or glue embolization
• Diagnostic cerebral angiography
• Balloon test occlusion

Diseases and Conditions

Minimally invasive, surgical therapies are available to treat the following diseases or conditions:

Cerebral Aneurysms

Weakenings in the blood vessels leading to the brain result in bulges, or aneurysms. If the aneurysm ruptures, life threatening bleeding, known as "subarachnoid hemorrhage" could occur. Sometimes, brain aneurysms are found by diagnostic testing. These un-ruptured aneurysms require close observation and sometimes-prophylactic treatment. However, ruptured aneurysms are diagnosed and treated urgently, either by surgical clipping or by endovascular coil embolization.

Endovascular coil embolization is a minimally invasive surgical technique in which very soft metallic coils made up of platinum material are positioned within the aneurysm. A small, keyhole incision is made in the groin and a plastic tube called a catheter is passed into the desired blood vessel. These tiny micro-catheters are threaded carefully under x-ray guidance and positioned within the aneurysm. Then the platinum coils are placed within the aneurysm. The procedure is generally performed under general anesthesia, while monitoring the patient's heart rate, blood pressure and intracranial pressures. At the end of the procedure the catheters are removed and the groin access is closed.

Advantages of coil embolization include eliminating the necessity of open surgery on the brain, and therefore a shorter recovery period. Your team of physicians, including a neurosurgeon and a neurointerventionalist, carefully reviews each patient's case and makes a recommendation about the appropriate type of treatment - either open surgery or neurointerventional technique to help you and your family make that decision.

Acute Ischemic Stroke

Stroke occurs when there is sudden blockage of the blood supply to the brain. It is the leading cause of serious, long-term disability with approximately 500,000 cases of stroke each year. It accounts for about 160,000 deaths, and in stroke survivors, there is a 25-29% recurrence rate over five years.

A clot busting medication known as "recombinant tissue plasminogen activator" or rTPA may be given to patients intravenously who come to the emergency room within three hours, and intra-arterially up to 8 hours, with or without mechanical thrombolysis (from the time their symptoms begin).

Abington Memorial Hospital's comprehensive stroke center is available 24/7 with the highest level of care for stroke patients. Because of the rapid availability of our neurointerventional team, patients are emergently taken to the angiography suite for further treatment. If a blockage of the blood vessel is found, "clot busting" medication may be infused through a tiny catheter into the site of vessel blockage or a clot retrieval device is used to remove the clot.

These techniques are performed under highly safe conditions, while experienced nurses continuously monitor the patient. After the procedure, patients are transferred to an intensive care unit for further monitoring.

Carotid Artery Stenosis

Stroke may be caused by narrowing of the large carotid artery that carries blood to the brain Carotid arteries are found on each side of the neck. As we age, the carotid artery develops plaque or hardens. These plaques can be dislodged and block these blood vessels.

Carotid artery angioplasty and stent placement is a way of treating symptomatic carotid arteries that have narrowed to 70% or more The procedure is performed under conscious sedation, and may be used in patients who are considered high risk for surgery and for patients who cannot undergo general anesthesia. The first part of the procedure is performed using the same technique described under cerebral angiography. Once the neurointerventionalist obtains the desired measurements, a tiny micro-wire is passed through the plastic catheter. The micro-wire includes a protection device in the form of an umbrella, which is placed in order to prevent any loose emboli from traveling towards the brain during angioplasty. Once the device is placed, a balloon is put across the narrowed area and inflated. Using fluoroscopic visualization, a stent is put in place. Any debris collected in the protection device is retrieved at the end of the procedure. Patients typically stay in the intensive care unit for one to two days. Blood-thinning medication is prescribed before and after the stent placement in order to prevent stroke.

Open surgery for carotid artery disease, called carotid endarterectomy, is still considered the treatment of choice for most carotid disease. Abington Memorial Hospital's neurosciences team including neurosurgeons, neurologists and neurointerventionalist, work together to ensure the appropriate treatment for each patient.

Atherosclerotic Intracranial Stenosis

Blood vessels inside the brain are also prone to narrowing or hardening. Called "intracranial atherosclerosis," about 70,000 people in the U.S. each year have an ischemic stroke caused by narrowed arteries. In most cases intracranial atherosclerosis is discovered during diagnosis when a patient has a stroke, or a mini stroke or "TIA". The risk of having a second stroke increases almost 10 times after the first stroke. Recommended treatments for intracranial atherosclerosis usually include exercise, healthy diet, and weight loss together with anti-platelet and cholesterol-lowering medications. In certain cases, the narrowing can be treated with the help of angioplasty and stent placement.

Intracranial angioplasty and stent placement is performed under general anesthesia, with close monitoring of the heart rate and blood pressure. The small plastic tube is passed through the artery in the leg (femoral artery). Through the catheter, first an angioplasty balloon is passed and the lesion is opened up so that the stent can be easily tracked and positioned across the narrowing. Once the stent is placed, it continues to exert a gentle outward force and prevents collapse of the blood vessel. After the procedure the patient is monitored in the ICU, and then followed closely after discharge.

 

Cerebral Arteriovenous Malformation/Vein of Galen Malformation and Cerebral and Spinal Arteriovenous Fistula (AVF)

Blood travels at a higher pressure from the heart through arteries to the brain. Inside the brain, blood is carried through smaller blood vessels known as capillaries, and ultimately carried back to the heart through veins. In arteriovenous malformations (AVM), an abnormal communication develops between an artery and a vein and thus blood flowing at high pressure through veins may cause bleeding inside the brain. AVM can be associated with headache, seizures, and sudden neurological changes.

The treatment of AVM is usually surgical, requiring complete resection of the abnormal communication and restoration of a normal blood supply. Sometimes surgical resection is assisted by either radiation therapy and/or endovascular embolization. The embolization is performed with the use of highly sophisticated small micro-catheters that once inside the brain, float with the blood and make their way into the region where pressure is higher. Once the neurointerventionalist reaches the desired position, liquid embolic agents such as ONYX or N-butyl cyanoacrolate in a mixture with radio-opaque material are injected into the AVM and slowly obliterate the shunt.

Epistaxis (nose bleeding)

Epistaxis is considered to be one of the most common ear, nose and throat emergencies. Although about 60% of adults suffer from nosebleeds, only 6% require medical management. Usually, conservative measures such as nasal packing or medications are indicated. Surgery or endovascular approaches are available for nosebleeds that are not controlled by medical management.

With endovascular therapy, the catheter is first placed in the main artery supplying the affected side (external carotid artery). Then a small micro-catheter is positioned into the branch that supplies the nose. Through the micro-catheter, embolic particles such as Polyvinyl Alcohol particles and Embospheres are injected.

For More Information:

To acquire more detailed information, please contact Neurosurgical Associates of Abington, 215-657-5886.

 

NEUROSURGICAL ASSOCIATES OFABINGTON
STE. 185, WILLOWOOD
ABINGTON HEALTH CENTER—SCHILLING CAMPUS
2510 MARYLAND ROAD
WILLOW GROVE, PA 19090
215-657-5886