SPECIALISTS WHO TREAT AND COMMONLY ASKED QUESTIONS ABOUT INTERVENTIONAL NEURORADIOLOGY
The Interventional Neuroradiology Service at Washington University School of Medicine is the largest in the region and one of the busiest in the country, offering patients with neurovascular disorders the benefit of evaluation and treatment by recognized experts in the field.SPECIALISTS WHO TREAT:
DeWitte T. Cross, III, M.D., Director
Colin P. Derdeyn, M.D.
Christopher J. Moran, M.D.
TO REFER A PATIENT, PHYSICIANS CAN CALL: (314) 362-5950 from 8 a.m. to 4:30 p.m. (CST) MONDAY - FRIDAY
Our patients are cared for at Barnes-Jewish Hospital, the most well-equipped and staffed facility in the region for management of neurovascular disorders. The Service is home to two $2 million dollar bi-plane digital angiographic units dedicated to neurovascular procedures. A team of specialized technologists and nurses assists with each procedure. Anesthesia is provided by separate adult and pediatric teams when needed.
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Common problems our experts treat include:
Aneurysms
Arteriovenous Malformations (AVMs)
Carotid Cavernous Fistulas (CCFs)
Carotid, Vertebral and Cerebral Arterial Stenoses
Strokes
Vascular Tumors
Vasospasm
Spinal Malformations
What is interventional neuroradiology?
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, but he can also 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.
Who benefits from interventional neuroradiology?
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 (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. Our 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, we offer 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.
What services do we offer?
We perform about 250-300 neuro-interventional procedures per year. Endovascular techniques are used to treat:
Aneurysms: Aneurysms are weaknesses in the wall of an artery that may rupture (burst) if not treated. A ruptured aneurysm may be fatal, however, not all aneurysms need to be treated and not all aneurysms should be treated from within the blood vessels. A variety of options are available for endovascular treatment including filling the aneurysm with soft platinum coils (GDC, Guglielmi Detachable Coils) and blocking the artery from which the aneurysm arises with a variety of different devices. Up to a third of patients with aneurysms in the arteries of the brain are treated from within the blood vessels at Barnes Jewish Hospital.
Arteriovenous Malformations (AVMs): 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 3rd or 4th decade of life. Rarely are infants or small children found to have an AVM. Surgery, radiation, and endovascular treatment are complementary techniques used for the treatment of these lesions. These abnormal vessels can be blocked with different materials injected through catheters (tubes) placed through the blood vessels into the lesion.
Carotid Cavernous Fistulas (CCFs): 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: Atherosclerotic disease or hardening of the arteries can cause severe narrowing (stenosis) of the arteries of the neck and brain. Sometimes these narrowings may cause a stroke (permanent damage to the brain from lack of blood supply) or temporary symptoms of a stroke. This can be from particles of a blood clot or plaque breaking free from the narrowing or from a reduction in the flow through the vessel because of the narrowing. In some patients, these narrowings can be opened using balloons inside the blood vessel. Sometimes we place metal tubes called stents in the vessel to help keep it open.
Strokes: Most strokes are caused by blood clots lodging in the arteries of the brain. These blood clots come from the heart or from atherosclerotic plaque in the 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.
Vascular Tumors: Patients with certain vascular tumors of the brain, head, neck or spine undergo embolization before surgery. Embolization refers to the blockage of arterial supply using small particles through a small catheter (tube). The advantages of embolization are that blood loss during surgery can be reduced, making surgery safer, faster, and potentially allowing a more complete removal of the tumor.
Vasospasm: 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 Malformations: 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.
What is cerebral or spinal 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 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.
Our patients are cared for at Barnes-Jewish Hospital and St. Louis Children's Hospital. 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. Our 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.
What about research?
Part of a long and successful research tradition through the Mallinkrodt Institute of Radiology and the Department of Neurology and Neurosurgery, our 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.
For more information about interventional radiology, including photos (angiograms) of aneurysms, coils and stents, and for "before" and "after" PET images, plus more, Click here for Interventional Neuroradiology Home Page