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NEURO INTERVENTIONAL RADIOLOGY
Intra-Cranial
Thrombolysis for Stroke Intervention
Acute ischemic stroke is a life threatening medical emergency. It is the
leading cause of disability and the third leading cause of death in the
United States. Ischemic stroke is the result of interrupted blood flow to
the brain, usually from a clot that has traveled from another part of the
body. They are associated with a neurological deficit that may
transient or permanent.
Symptoms of stroke may be variable depending upon the part of the brain that
is affected. They may include change in mental status, weakness or loss of
function in extremities or facial muscles, visual disturbances, difficulty
or inability to speak or comprehend. Once symptoms are recognized it is
imperative that you seek medical attention immediately. An ischemic stroke
in progress often can be reversed with the use of “clot busting”medications.
The drug may be administered intravenously or intra-arterially. Highly
trained physicians called Neuro-Interventional Radiologists, insert tiny
catheters into the affected artery and deliver medication directly into the
clot. These medications “dissolve” the clot and restore blood flow to brain
tissue.
Treatment may be beneficial despite extent of neurological deficit.
Typically, with
intravenous thrombolytics the “window of opportunity” is three hours. With
intra-arterial infusion, treatment may be initiated up to six hours after
onset of symptoms. However, length of time from onset of symptoms to
initiation of treatment is crucial to obtain the best possible outcome.
Embolization of Cerebral Aneurysms
Aneurysms are weakened areas of a vessel wall. It is unclear why they occur
and their incidence tends to increase with age. They can occur in any
vessel, but primarily affect the large arteries in the body. They may also
affect blood vessels in the brain.
Cerebral aneurysms are not uncommon and may affect as much as 5% of the
population over the age of 65. Untreated, the aneurysm may rupture resulting
in a subarachnoid hemorrhage, or bleeding in the brain. Mortality is high.
It is estimated that 10% of patients with ruptured aneurysms die before
reaching the hospital, 50% eventually die from complications associated with
the bleed and 25% suffer permanent neurological deficits (Putnam et. al).
Cerebral aneurysms have historically been treated with open surgery. This
requires the physician, a neurosurgeon, to open part of the skull and
identify the aneurysm. Then, a clip is placed to occlude blood flow into the
affected part of the artery. This is a very effective treatment method but
is highly invasive.
Endovascular treatment with coil embolization is another very effective
treatment option that is minimally invasive. A Neuro-Interventional
Radiologist inserts a very small catheter into the artery in the groin. The
catheter is advanced into the aneurysm. Minute particles are then packed
into the aneurysm to occlude blood flow and prevent rupture of the aneurysm
or prevent repeat bleeding if rupture as already occurred. Coiling is less
invasive and requires much less recovery time.