Interventional neuroradiologists treat disorders of the blood vessels of the brain, spine, head and neck using a minimally invasive approach, usually working from within the blood vessels. The tools of an interventional neuroradiologist are tiny catheters (tubes) and precise imaging equipment, allowing procedures to be performed through small incisions in the skin, directly inside the affected blood vessels.
The interventional neuroradiology service at the Barnes-Jewish & Washington University Neuroscience Center is the largest in the region and one of the busiest in the country, with recognized experts in the field.
Benefits of Interventional Neuroradiology
As computer and imaging technology has advanced, the options available to interventional neuroradiologists have grown phenomenally. Because of the risk involved with treating blood vessels in such critical areas as the head, neck and spine, using small incisions and image-guided precision results in better treatment and outcomes for our patients. Our goal is to offer each patient the most effective treatment with the lowest risk.
Patients with known or suspected disorders of the cerebral blood vessels are usually evaluated in close consultation with members of the neurology and neurosurgical departments, or the vascular surgery department. A weekly conference is dedicated to discussing the best treatment for patients with these problems.
Treating Blood Vessels of the Head, Neck and Spine
We perform about 250-300 interventional neuroradiology procedures per year. 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.
In addition to vascular disease, we offer other treatments 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.
Other common endovascular techniques and treatments include:
Aneurysms are weaknesses in the wall of an artery that may rupture (burst) if not treated. A ruptured aneurysm may be fatal. A variety of options are available for endovascular treatment, including filling the aneurysm with soft platinum coils and blocking the artery where the aneurysm arises. Sometimes stents or balloons are used to help keep the coils in the right place. At Barnes-Jewish Hospital, up to two-thirds of patients with aneurysms in the arteries of the brain are treated using interventional neuroradiology techniques.
Angiography is used to examine blood vessels in the head, neck, brain or spine. It is more accurate and provides better quality of resolution 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 dye is injected to make 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.
Arteriovenous Malformation (AVM) Catheterization
AVMs are abnormalities of the arteries and veins in which a direct connection, or short circuit, exists between the arteries and veins. Most are congenital, meaning patients are born with this connection. Symptoms of headaches, seizures or bleeding do not usually appear until the 30s or 40s. These abnormal vessels can be blocked with different materials injected through catheters (tubes) placed through the blood vessels into the lesion.
Carotid Cavernous Fistula (CCF) Treatment
CCFs are an uncommon but unique subgroup of AVM which are primarily acquired later in life than AVMs. They can be separated into direct connections between the carotid artery and the veins of the cavernous sinus (usually due to trauma) or indirect connections in which small arterial branches supply the veins. Both types can be treated very effectively with different endovascular devices.
Cerebrovascular Stenosis Treatment
Atherosclerotic disease, or hardening of the arteries, can cause severe narrowing (stenosis) of the arteries of the neck and brain. Sometimes this narrowing may cause a stroke (lack of blood supply) or temporary symptoms of a stroke. In some patients, this narrowing can be opened using balloons inside the blood vessel. Sometimes metal tubes called stents are placed in the vessel to help keep it open.
Most strokes are caused by blood clots lodging in the arteries of the brain. These blood clots come from the heart or from plaque in the blood vessels anywhere from the heart to the brain. If the blood clot blocks the artery for long enough, the brain cells ordinarily supplied by that artery die from lack of oxygen and nutrients. In some patients, the blockage can be dissolved using powerful blood clot-dissolving drugs given at the surface of the clot through small tubes or removed using devices that can pull the clot out.
Vascular Tumor Surgery and Embolization
Patients with certain vascular tumors of the brain, head, neck or spine undergo embolization before surgery. Embolization prevents blood flow to the area of the tumor. The advantages of embolization are that blood loss during surgery can be reduced, making surgery safer and faster, potentially allowing a more complete removal of the tumor.
Vasospasm - Vessel Dilation
When an aneurysm ruptures, the bleeding over the surface of the brain sets in motion a cascade of chemical events that results in severe narrowing of the arteries of the brain several days after the rupture. This narrowing may be so severe that medical treatment to keep enough flow through the vessel may fail. In these patients we can often open their arteries by directly administering different drugs and using balloons to dilate the vessels.
Spinal Malformation Treatment and Testing
Arteriovenous malformations (AVMs) and vascular tumors often involve the spine or spinal cord. Endovascular techniques may be used prior to surgical treatment or as the sole treatment of these lesions. In addition, we also perform a variety of non-vascular procedures in the spine. These include biopsies, nerve root injections for pain relief, and diagnostic discograms (a test for painful spinal discs).
For a referral to a Washington University neurologist or neurosurgeon at Barnes-Jewish Hospital, call 855.925.0631.