Large aneurysm
arising at the
bifurcation (branch
point ) of the left
internal carotid
artery (in the brain)
before treatment.
 

Carotid arteriogram
following GDC coil
embolization a large
aneurysm. The
aneurysm no longer
fills with x-ray dye,
as it is filled with
coils instead,
preventing the
risk of future rupture.


Before

After

A large intracranial
(AICA) aneurysm
before and after
endovascular
occlusion with
GDC coils.

Interventional Neuroradiology

Interventional neuroradiology is a rapidly growing and exciting area in Interventional Radiology. This subspecialty deals primarily with the endovascular therapy of disorders of the brain and spinal cord. Using state of the art digital angiography equipment, microcatheters are navigated through the arteries and veins of the brain to treat a wide variety of neurovascular pathology. Over the last 10 years, we have witnessed significant advanced in both the numbers and safety of neurointerventional procedures and the growing acceptance of these procedures by various specialties such as neurosurgery, neurology, plastic surgery and ear, nose, and throat (ENT).

The proper performance of embolization procedures requires a major commitment to patient care by a dedicated multidisciplinary team including the radiologist, the neurosurgeon, the neurologist, the neuroanesthetist, the physiatrist as well as the intensive care unit and nursing staff. RCT and Saint Francis Hospital have made this commitment and have established the most comprehensive Interventional Neuroradiology program in the state of Oklahoma.

Following is a description of the some of the procedures RCT physicians perform, along with images that show the dramatic results produced using these techniques.

     
  • Gugleilmi Detachable Coil (GDC)

  • The GDC is used for embolization of cerebral aneurysms. Using fluoroscopic guidance, the tip of a microcatheter is placed within the center of an aneurysm. Finely drawn loops of platinum wire are successively placed within the aneurysm resulting in the closure and eventual fibrosis (scarring of the aneurysm). This has proven especially useful for patients in whom aneurysm rupture has already occurred or in patients whose underlying medical condition makes tradtiional neurosurgical therapy unsafe. Both effective and safe, GDC coils represent a valuable treatment option for many patients.

    RCT has performed more GDC coil procedures than have been performed at all of the other hospitals in Oklahoma combined, with excellent results.
     

  • Thrombolytic Therapy

  • If the symptoms of a stroke can be detected before a significant brain injury has occurred, many patients may benefit from thrombolytic therapy. Thrombolytic medicines dissolve the blood clots within the cerebral arteries allowing a more rapid restoration of blood flow to the brain. This may halt or minimize the damage to the brain and allow more complete recovery of function. The intra-arterial administration of these thrombolytic agents directly within the clot itself has been shown to produce more effective restoration of blood flow when compared to the non-selective administration of these medicines through a peripheral vein.

    The Interventional Radiology section at Saint Francis works closely wiht the emergency room physician and the neurologist to rapidly diagnose and treat this potentially debillitating problem.
     

  • Pre-operative Embolization

  • of Arteriovenous Malformation
    Traditionally, the treatment of highly vascular lesions has been surgical resection. Performed under the operating microscope, these surgeries were quite tedious, often lasting several hours and often associated with significant intraoperative blood loss. 

    The preoperative embolizaiton of the abnormal arteries of the malformation has dramaticlaly improved both intra- and postoperative results, reducing morbidity and mortality by as much as 50 percent.

    More recently, many AVMs are treated by very precise, computer directed radiation therapy. This is especially effective with smaller malformations where more of the radiation beam can be focused on the malformation. Again, pre-treatment embolization of AVMs by the interventional neuroradiologist can make sterotactic radiotherapy safer and more effective.
     
  • Pre-operative Embolizatin of Tumors of the Brain, Neck, and Spinal Cord

  • One of the more common tumors to affect the brain is a meningioma, a benign tumor arising from the coverings of the brain. The pre-operative embolizatin of these lesions, especially when they are large, has been shown to reduce operative complications and lead to shorter hospital stays. The use of intracranial intra-arterial chemotherapy for primary malignant tumors of the brain has not been consistently effective.

    Many vascular tumors of the neck and skull base respond very favorably to pre-operative embolization. This technique is gaining wide acceptance with the ENT surgeon.

    Metastatic tumors often spread to the spine. Operative therapy can be associated with excessive blood loss. These patients may benefit from preopeartive embolization.
     

  • Methacrylate Vertebroplasty

  • Compression fractures of the spine are an all too common occurrence among the elderly. Typically, related to osteoporosis, a loss of the minieral content of the bone, compression fractures are quite painful and lead to significant loss of mobility in those patients. The x-ray directed placement of bone cement into the collapsed verteral body usually results in the prompt relief of, or significant improvement in back pain. This allows a quicker return to normal activities and an improved quality of life.
Conditions for which INR procedures are commonly used.
  • Cerbral aneurysms

  • Usually acquired in mid-life, often in conjunction with hypertension and atherosclerosis, aneurysms are defects in the walls of the arteries of the brain. Resembling small bubbles or blisters on the arterial wall, they become progressively larger over time. If the aneurysm ruptures, bleeding occurs into or around the brain often resulting in death or permanent neurologic disability (stroke).
     
  • Arteriovenous Malformations (AVMs)

  • These congential lesions, present at birth, represent a disorganized tangle of abnormal arteries and veins wihtin the substance of the brain. Associated with cerebral anuerysms, these vascular malformations can be a cause of seizures and hemorrhage within the brain
     
  • Stroke

  • A leading cause of death and permanent disability among Americans, stroke occurs when an artery within the brain is blocked, usually by a blood clot coming from the heart or from arterial blockage of the arteries in the neck. The part of the brain supplied by the blocked artery rapidly becomes ischemic (suffers from an inadequate supply of oxygen) and brain injury results, which may impair speech, movement, memory or vision.
     
  • Brain Tumors

  • A number of benign and malignant tumors of the head and neck can be treated by INR. Embolization of the arterial supply of vascular tumor of the head and neck has become an accepted preoperative adjunct. Intracranial intra-arterial chemotherapy may be useful for the treatment of metastases or primary tumors of the brain.
Diagnostic Angiography

Peripheral Angioplasty

Venous Intervention &
Dialysis Access Management

Central Venous Access Catheters

Thrombolysis

Interventional Neuroradiology

Embolization

Imaging Guided Biopsy/Abscess Drainage

Biliary Intervention for
Disorders of the Liver

GU Intervention

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