Understanding Interventional Radiology
Interventional neuroradiology (INR) is a new but growing specialty primarily dedicated to the treatment of disorders of the blood vessels of the brain, spine, head and neck from inside those blood vessels (an endovascular approach).
Using catheters and microcatheter techniques, an interventional neuroradiologist can reduce or eliminate blood flow to abnormal structures such as aneurysms or vascular formations. An interventional neuroradiologist also can use endovascular techniques to increase blood flow to normal blood vessels that are obstructed by clot or atherosclerotic disease.
Advances in the computer technology that provides the images used to guide catheters and other devices within the body, as well as advances in the devices themselves, account for the phenomenal growth of this field.
Understanding Angiography
An angiography is an examination to evaluate blood vessels in the head, neck, brain, or spine that provides an accuracy and quality of resolution better than any other imaging technique at this time.
Using local anesthesia, a catheter is placed in an artery in the groin and then directed to the vessels to be examined. Once the catheter is in position, a contrast agent ("dye") is injected into the artery which makes the selected blood vessels visible on X-ray. The procedure typically lasts about an hour. Washington University interventional neuroradiologists perform about 1,000 diagnostic cerebral and spinal angiograms per year in addition to the 250-300 angiograms performed for interventional procedures.
Patients Benefiting from Interventional Radiology
A growing number of patients with diseases or disorders of the blood vessels of the neck, head and spine can be treated safely and effectively using devices within the blood vessels (referred to as endovascular).
Common endovascular therapies include angioplasty (opening a narrowed artery with a balloon) and treatment of aneurysms (a balloon-like weakness in the wall of an artery) within the head.
Many vascular problems are complicated and require different combinations of medical, surgical, and endovascular treatment for the best outcome. The goal is to offer the patient the most effective treatment with the lowest risk. In some cases, this may be no treatment at all.
In addition to vascular disease, the Mallinckrodt Institute of Radiology offers other percutaneous (through small skin punctures) interventions related to the head, neck, spine, and nervous system. These include injections of anesthetics and steroids for relief of pain from nerve root inflammation and image-guided biopsies to obtain diagnoses.
Patients with known or suspected disorders of the cerebral vasculature are usually evaluated in close consultation with members of the Departments of Neurology and Neurological Surgery or the Section of Vascular Surgery. A weekly conference is dedicated to discussing the best treatment for patients with these problems.
All adult and pediatric procedures are performed on the 3rd floor of the Mallinckrodt Institute of Radiology, just off the main lobby of Barnes-Jewish Hospital (South campus). In addition to the dedicated interventional neuroradiology angiographic suites, there are four dedicated neurosurgery operating rooms equipped to perform any neurological procedure.
The 20-bed neuro-intensive care unit (NICU) is one of the largest and most sophisticated in the United States, ensuring that after surgery, patients are cared for by specialized physicians, nurses and other staff, including a neurointensivist, a physician specialty-trained in caring for patients in the NICU. The NICU has computerized radiograph viewing and an in-unit positron emission tomography (PET) scanner - a leading-edge brain imaging technique invented and developed at Washington University.
Interventional Radiology Treatments and Services
The interventional neuroradiologists at Mallinckrodt Institute of Radiology perform about 250-300 neuro-interventional procedures per year. Endovascular techniques are used to treat:
- Aneurysms
- Arteriovenous Malformations (AVMs)
- Carotid Cavernous Fistulas (CCFs)
- Cerebrovascular Stenosis
- Spinal Malformations
- Strokes
- Vascular Tumors
- Vasospasm
Interventional Radiology Research
Part of a long and successful research tradition through the Mallinkrodt Institute of Radiology and the Department of Neurology and Neurosurgery, the team of interventional neuroradiologists are actively involved in research aimed at improving the diagnosis and treatment of patients with neurovascular disorders. Current areas of interest include the development of improved guiding systems, the evaluation of new interventional devices, and the measurement of the hemodynamic and metabolic effects of endovascular therapy.
Interventional Radiologists at Barnes-Jewish Hospital
Michael Darcy, MD, Chief
James Duncan, MD, PhD
Jennifer Gould, MD
David Hovsepian, MD
Daniel Picus, MD
Suresh Vedantham, MD
Thomas Vesely, MD