Washington University interventional neuroradiologists at Barnes-Jewish Hospital, including Akash P. Kansagra, MD, are using minimally invasive procedures for treating brain aneurysms and strokes to improve outcomes for patients.
I’m an interventional neuroradiologist, which is a sub-specialty of radiology focused on the treatment and diagnosis of abnormalities of the blood vessels in the brain and spine.
I use devices inside of the blood vessels to treat conditions such as aneurysms of the brain, acute stroke and other vascular abnormalities that would affect the brain and spine.
So the main conditions we see as interventional neuroradiologists are things like aneurysms of the brain, acute stroke, which is a blood clot that has lodged in one of the vessels of the brain and things of that sort. Conditions which would cause bleeding in the brain or the opposite, blood clot which is not enough blood flow to the brain. That is, those are the things we see most often, although we treat a variety of disorders that extend beyond that, such as brain tumors and other sorts of tumors in the brain and spine.
Nowadays there’s a variety of different methods to treat aneurysms, including surgery, which is the conventional historically most available option. As an interventional neuroradiologist, to treat an aneurysm we can actually carefully position a very, very thin tube into the aneurysm using x-rays to guide us all the way from the upper part of the leg all the way into the brain.
Once that tube is positioned we can actually fill that aneurysm entirely with a variety of devices to help stop blood flow from entering the aneurysm and thus taking away the risk of the aneurysm rupturing and causing a devastating neurologic illness.
To treat a stroke, the way that strokes have been, are treated nowadays is completely different than they were just five years ago. So, the conventional method of treating a stroke was to administer the patient medication which would help to dissolve a blood clot. As an interventional neuroradiologist I can add to that treatment strategy by also navigating a catheter, which is a very small tube, into the blood clot and physically removing that blood clot. So between the two of these methods, dissolving the blood clot and physically removing it, patients have been shown to have great outcomes and have a much better chance of recovering from a stroke.
Just in the last couple years there have been a series of clinical trials that have come out that have demonstrated beyond any doubt that for appropriately selected patients, patients with severe stroke due to a particular type of blood clot in the brain, benefit tremendously from having the clot physically retrieved.
Based on these new clinical trials there is overwhelming evidence that patients who are treated with a combination of not just the clot-busting medications, but also with physical retrieval of the clot by an interventional neuroradiologist, do much better. That they’re much more likely to be independent and able to live on their own once they leave the hospital. That’s a fate that they did not have the option of living just a few years ago and nowadays it’s generally understood that for patients who are having a severe stroke, interventional neuroradiology and other specialists who can also retrieve those clots can really make a big impact on how well they’ll do in their future.
Barnes-Jewish Hospital and Washington University have provided a great, great place for me to actually perform my, to work in my specialty. Fundamentally, the specialty of interventional neuroradiology sits at the crossroads of neurosurgery, radiology and neurology. And it’s a rare, a rare hospital that can combine the, combine strong departments in neurosurgery, neurology and radiology all into one place.
At Barnes-Jewish Hospital and Washington University I have the opportunity to work with experts in each area and see a very high level, high complexity cases, patients that aren’t able to be treated elsewhere. Those patients come to Barnes-Jewish Hospital for treatment. I get to treat those patients. And I have the option of working with experts in other areas when treatments using these interventional neuroradiology methods are not appropriate I have the option of referring patients to other experts in other departments and know that they’ll receive expert care.