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NeuroIntervention

As with any medical specialty, the field of neurology continually pursues new technologies with the goal of providing more advanced treatment choices to a broader patient population. NeuroIntervention, treatment of neurological disorders from within the blood vessels or endovascularly, has recently emerged as an area of neurological expertise — offering new hope to patients who had been told previously that they had no further treatment options.

NeuroInterventional Procedures

All of the procedures detailed below require a special angiography machine that allows for two simultaneous viewing angles and the expertise the StrokeCareNow Network's Neuro-Interventional Service. These treatments are only available in "comprehensive stroke centers" such as Parkview Hospital or Lutheran Hospital in Fort Wayne, Indiana.

Coiling
Coiling of an Aneurysm

Aneurysm Coiling
The formation of an aneurysm starts with a weakness in an artery wall. High blood pressure can cause the weakened blood vessel to bulge outward and form a blood filled pouch — an aneurysm. If the aneurysm ruptures, an often devastating, if not fatal, hemorrhagic stroke results. Although for some patients conventional open brain surgery is necessary due to the location of the aneurysm, clinical research trials have proven that the less invasive NeuroInterventional endovascular treatment of "coiling" an aneurysm is a safer and more effective treatment option. In a "coiling" procedure a small catheter is placed into the femoral artery of the patient's leg and then threaded through the blood vessels and up into the brain. The NeuroInterventionalist guides the catheter with the aid of specialized fluoroscopic radiology equipment. Platinum coils are then placed into the aneurysm. This prevents further blood blow and stabilizes the aneurysm, thereby preventing a potentially deadly rupture.

Arteriovenous Malformation (AVM) Embolization
An AVM is an abnormal tangle of blood vessels within the brain. The patient is born with this abnormality and over time the patient may experience headaches, seizures or bleeding from these poorly formed blood vessels. Often patients may not have any symptoms, yet the abnormality is found by chance during testing for a different condition. Treatment of symptomatic and even asymptomatic AVMs is recommended as the risk of complications from an untreated AVM increases with age. NeuroInterventional treatment of an AVM involves reducing blood flow to the area by introducing a glue-like substance into the AVM via a catheter threaded up to the brain through the femoral artery. This treatment is not a cure but is most often is used as an adjunct treatment to surgical or radiation treatment as the endovascular treatment blocks blood flow to the AVM and thereby reduces the risk of bleeding during additional treatments.

Ischemic Stroke - Intra-arterial Thrombolysis and Embolectomy
Ischemic stroke patients who cannot receive intravenous tPA or whose occluded brain vessels fail to open with intravenous tPA may be candidates for intra-arterial thrombolysis or catheter-based treatments

In intra-arterial thrombolysis the clot busting medication tPA is directly delivered to the blood clot through a small catheter or tube threaded up to the brain through the patient's femoral artery.

An additional treatment option is called mechanical embolectomy and involves the removal of the blood clot with a device delivered endovascularly to the site of the clot within the brain.

The Merci Retrieval System®
The MERCI Retriever

The Merci Retrieval System®
One type of embolectomy procedure involves the use of The Merci Retrieval System®. A Merci Retriever® consists of a small corkscrew that is delivered to the brain through a catheter and placed behind the blood clot. A balloon is inflated in the neck shutting off blood flow to the brain as the clot is pulled and sucked out of the brain. Click here to be directed to the Merci Retrieval System® website.

The Penumbra System
The Penumbra system

The Penumbra System®
Another embolectomy procedure uses The Penumbra System® - a set of special very flexible catheters and "cleaning wires" that are used to directly suck the blood clot from the brain. Click here to be directed to The Penumbra System® website.

Carotid Stenting
The carotid arteries are the large blood vessels located on each side of the neck that carry blood to the brain. A blood clot or atherosclerosis (cholesterol build-up) in a carotid artery can decrease blood flow to the brain or even completely cut off the blood supply resulting in a stroke. Conventional treatment of carotid stenosis over the past 50 plus years has involved a surgical procedure called an endarterectomy. However, some patients are not eligible for this surgical procedure and the development of the endovascular carotid stenting procedure has become an important alternative treatment option. During a carotid stenting procedure a filter device is placed beyond the carotid stenosis to capture any debris that might break off during the procedure. Clinical research trials have shown that the use of such a filter is key in decreasing strokes associated with carotid stenting procedures. A mesh tube called a carotid stent is then placed in the artery at the site of the narrowing and expanded to open the artery.