Acute Stroke Treatment

Endovascular treatment of stroke is the nonsurgical treatment for the sudden loss of brain function due to blood clots. Our team inserts thin tubes called microcatheters into the groin and travel to the brain to capture and remove the blood clot causing the stroke. This procedure is called a thrombectomy.

The procedure:

• should ideally be done as soon as possible after onset of acute stroke symptoms.
• can benefit some patients under certain conditions if done even within 24 hours of symptom onset.
• should include IV recombinant tissue plasminogen activator (tPA) treatment in eligible patients.

Aneurysm Treatment

A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. Most brain aneurysms don’t rupture, create health problems or cause symptoms. However, a brain aneurysm can leak or rupture, causing bleeding into the brain (hemorrhagic stroke). A ruptured brain aneurysm most often occurs in the space between the brain and the thin tissues covering the brain. This type of hemorrhagic stroke is called a subarachnoid hemorrhage.

A ruptured aneurysm quickly becomes life threatening; it’s imperative to seek prompt medical treatment.

Aneurysms are usually treated in one of two ways:

• Clipping: To get the aneurysm, the neurosurgeon must go through the skull with a procedure called a craniotomy (a piece of bone will be removed from the skull during the surgery). In this type of procedure, a surgeon locates the blood vessel with the aneurysm and places a spring-loaded metal clip across the base of the aneurysm where it comes off the artery. This clip cuts off the blood flow into the aneurysm, thereby minimizing the risk that the aneurysm could rupture in the future. The bone is reattached, and the skin sutured closed. Use of this surgery depends on the location and size of the aneurysm, as well as the overall health of the patient.
• Coiling: Sometimes an aneurysm is not in an area where a clip can be applied, so an alternate therapy called coil embolization or coiling is used to get into the blood vessel. In contrast to surgery, endovascular coiling does not require open surgery. Instead, the physician inserts a catheter (small plastic tube) into the femoral artery in the patient’s leg and navigates it through the blood vessels into the brain and into the aneurysm. Tiny platinum coils are threaded through the catheter into the aneurysm. A small electrical current heats the coils and allows them to expand and block off the aneurysm. The catheter is then taken out, and the patient is sent to intensive care (ICU) for observation.

In aneurysms with large openings from the artery (known as wide-neck aneurysms), our team may elect to use additional devices such as a metal stent (a tiny hollow metal tube with holes in it that acts as a scaffold within the vessel) or a balloon. These devices are designed to help to keep the coils in place inside the aneurysm. In stent-assisted coiling, a permanent stent is placed in the artery where the aneurysm branches off to help keep the coils in place. Balloon-assisted coiling involves temporarily placing a removable balloon where the aneurysm branches off the artery in order to help keep the coils in place.

AVM Treatment

Arteriovenous Malformations

A brain arteriovenous malformation (AVM) is a tangle of abnormal blood vessels connecting arteries and veins in the brain; patients are born with this malformation. Treatment depends on the patient’s age, health and the size and location of the AVM.

Surgery is the most common treatment for brain AVMs. One option is for an endovascular surgeon to perform an endovascular embolization.

In this procedure, your doctor inserts a long, thin tube (catheter) into a groin artery and threads it through blood vessels to your brain using X-ray imaging.

The catheter is positioned in one of the feeding arteries to the AVM and injects an embolizing agent to block the artery and reduce blood flow into the AVM. This may be repeated in multiple feeder vessels with the goal of reducing blood flow to the AVM.

Endovascular embolization is less invasive than traditional surgery. It may be performed alone but is frequently used prior to other surgical treatments to make the procedure safer by reducing the size of the AVM or the likelihood of bleeding.

In some large brain AVMs, endovascular embolization may be used to reduce stroke-like symptoms by redirecting blood back to normal brain tissue.

Endovascular Care Resources