The Stroke & Cerebrovascular Center offers the very latest innovative therapies to our patients, many of which we have pioneered or helped to develop. These advanced, new treatments often mean shorter recovery times, less risk and overall better outcomes than older therapies. Because the newer treatments avoid the need for major operations, they maximize the likelihood of a full recovery for many patients.
Endovascular therapy
Perhaps the most exciting advance is the ability to perform minimally invasive procedures on the brain and blood vessels. This is known as endovascular therapy. Using miniature high-tech tools, physicians can create tiny openings in the body and pass the tools they need to repair neurological damage through the holes to the site of the problem. They then can mend the problem from within the blood vessel rather than having to cut it open via external surgery. The delicate procedures are guided by highly sophisticated, real-time brain monitoring and neuroimaging equipment.
Endovascular treatments available at the Stroke & Cerebrovascular Center include:
Carotid Bypass Procedure
The carotid artery is a major blood vessel that brings blood from the heart, through the neck, to the brain. If this artery is partially or completed blocked (“stenosed”), it could cause a stroke. But in some patients, it is possible to bypass the blockage, allowing an adequate flow of blood to the brain and preventing strokes from recurring.
Carotid bypass procedures are also used following complex operations in or near the brain to allow blood flow to the brain when normal routes have been altered by the surgery.
Intra-arterial thrombolysis
After confirming that a stroke has occurred, many stroke patients are treated within three hours of the onset of symptoms with a clot-dissolving drug called Tissue Plasminogen Activator (tPA). Our experienced Stroke & Cerebrovascular Center endovascular neurointerventionalists have been performing a more advanced version of this treatment—intra-arterial thrombolysis—since 1993. This method allows tPA to be delivered straight to the source of the clot, instead of waiting for it to flow from a vein into the bloodstream and to the brain. This treatment can be given up to six hours after the onset of a stroke. And our endovascular neurointerventionalists are on-call 24 hours a day, seven days a week.
Microcatheters
A variety of cerebrovascular problems can be treated with minimally invasive therapy rather than a major operation. Some examples are intracranial aneurysms, vascular malformations, carotid stenoses and acute ischemic stroke.
Such minimally invasive procedures are possible in part because of innovative equipment and instrumentation that can be used on the body without the need to make a large incision. Such equipment includes:
- Microcatheters: An extremely thin, soft and hollow tube that is gently navigated into the body for other instruments to passed through and directed to the point where they are needed.
- Microcoils: Spring-shaped, bendable coils that can unwind to “fill up” a defect, such as an aneurysm, safely stopping blood flow.
- Liquid adhesives: These are a kind of “glue” that can be used in the body to block off blood vessels, for example, in an AVM.
Stents
Until now, certain kinds of aneurysm could not be easily treated either with an open operation or an endovascular procedure. The development of intracranial stents has changed all that, however.
An intracranial stent is a tiny tube that can act like a miniature scaffolding to hold open a blood vessel during aneurysm repair with microcoils, allowing coil placement even in difficult-to-reach parts of the brain.