Neurointerventional Radiology

A subspecialty of clinical radiography, neurointerventional radiology specialises in using medical imaging tests to diagnose and treat the disorders affecting the blood vessels of the central nervous system, which involves the head, neck, and spine. Interventional radiologists use imaging and guidance techniques to guide catheters and other equipment around the arteries and veins in the central nervous system to treat conditions like strokes and aneurysms. Better results are achieved with the procedure because it is less invasive and eliminates the need for traditional surgery. In order to guide the insertion of tiny catheters, wires, stents, and other devices through the blood vessels and into the targeted location, it employs sophisticated and contemporary techniques and tools. These tools can remove clots, unblock narrow or obstructed veins, impede blood flow, and provide medications. This approach is superior to regular surgery in many ways.

What is Interventional Neuroradiology ?

It is a subspecialty of interventional radiology, mainly aiming at minimally invasive procedures to diagnose and treat conditions affecting the brain, spine, and nervous system. Neuro-interventional radiologists use imaging guidance, like X-rays, fluoroscopy, and MRI, to carry out surgeries through tiny incisions or, in some cases, no incision at all. The main goal of interventional radiology is:

• To treat conditions many vascular diseases mainly affecting the brain and spine
• To treat these conditions without any major incision or blood loss
• To treat with less pain, fast recovery, and better outcomes

Disease treated by Neurointerventional Radiologists

Stroke

It is a condition caused due to a lack of blood supply to the brain. Due to the lack of blood supply, brain cells get damaged, resulting in strokes. There are two types of strokes:

• Ischemic stroke: It is a condition where the brain cells don’t get enough blood with oxygen. It is caused by the blockage of blood vessels in the brain. It leads to blood clots.
• Haemorrhagic stroke: It is a condition that causes bleeding in or around the brain. It may be due to bleeding inside the brain or in the subarachnoid space between the brain and the outer space. 

The symptoms of ischemic stroke are sudden onset of paralysis, double vision, difficulty in speaking, imbalance. Any one or combination of above symptoms if occur suddenly can be onset of stroke. However, for haemorrhagic stroke, sudden severe headache, which is classically described as the “Worst headache of your life” is the predominant symptom. Other symptoms can include paralysis, loss of speaking ability, loss of muscle control, loss of one or more senses (like vision, hearing, smell, or taste), nausea, vomiting, neck stiffness, memory loss, fainting, seizures, and emotional instability. 
In few cases it may also cause sudden death.

Arteriovenous malformation (AVM)

AVM is a condition where an abnormal tangle of blood vessels occurs in the body. The arteries, which pass blood to the brain, and veins, which drain blood from the brain, are tangled up in the form of a bird nest, affecting the blood flow to the brain. The blood exchange takes place in the capillaries, where the smallest blood vessel units of arteries and veins connect. During this condition, due to the tangle-up of arteries and veins, capillaries that connect the arteries and veins are damaged and destroyed. This results in the direct connection of high-flow arterial blood to the veins. As a result of abnormal connections between the arteries and veins, the vessels rupture, leading to bleeding in the brain. AVM is of two types:

• Brain AVM: This type develops anywhere within the brain tissue, such as the brainstem and spinal cord. 
• Peripheral AVM: This type develops in other parts of the body other than the brain, like hands, legs, face, heart, or lungs.

Though AVM may remain silent for years together but once it ruptures/bleeds, the symptoms include seizures, severe headaches, paralysis, dizziness, hallucinations, numbness of the face and neck, mental confusion, severe cough (if it is affecting the lungs), and shortness of breath.  

Brain aneurysm

A brain aneurysm is often known as a cerebral aneurysm. It is characterised by the formation of a bulge in a weak area of an artery in and around the brain. The bulge is formed when the constant high pressure of blood flow pushes the weak area of arteries outwards, leading to a blister-like bump. As the blood rushes into the bulge, it gets stretched even farther. It is mostly seen in the major arteries at the base of the skull, frequently at the branch points. When the bulge/aneurysm is stretched, it leaks or ruptures, causing bleeding in the brain, which is a life-threatening condition. The symptoms include:

Thunderclap headache

• Vasospasm
• Seizures
• Photophobia
• Confusion
• Loss of consciousness
• Blurred vision
• Stiff neck
• paralysis

Carotid Stenosis

Carotid atherosclerosis, often known as carotid artery stenosis, is a condition caused when the carotid artery (the largest artery in the neck) is blocked or gets narrow/stenosed by a substance called plaque, which is a fatty cholesterol deposit. This blocks the normal blood flow through the carotid arteries or reduces it leading to a high risk of stroke. The human body has two carotid arteries, one on each side of your neck. It carries blood to the brain, face, and head. The atherosclerosis may appear in any of the carotid arteries in the neck. Perse the stenosis remains silent till a stroke occurs. Sometimes it causes transient symptoms which resolve within few seconds or minutes. This is called Mini Stroke or Transient Ischemic Attack (TIA). This can be a sign for a bigger stroke in future. The signs and symptoms of Mini Stroke or Stroke may include:

• Paralysis of arm/leg
• Slurred speech
• Loss of vision/double vision
• Loss of balance
• Drooping of one side of face
• Confusion

Cerebral venous sinus thrombosis

It is a condition of blood clots in the brain’s larger veins called dural sinuses. Veins are the bllod vessels which take the bllod from the brain to the heart. When a blood clot is formed in large veins, the blood flows in a different direction, which increases the pressure in the brain and causes swelling and sometime bleeding in the brain. Blood clots may appear in the transverse sinus, superior sagittal sinus, inferior sagittal sinus, sigmoid sinus, cavernous sinus, and deep sinus of your cortex. The symptoms include:

• Headache
• Seizure
• Stroke
• Double vision

Treatments done by Interventional Neuroradiologist:

Brain Aneurysm Treatment:

Endovascular repair /Coiling:

In this form of treatment, the neurointerventional radiologist threads a catheter and thin wire through blood vessels into the aneurysm. A coil of platinum wire, which is as thick as a strand of your hair, is released into the area. The coil acts as a net, preventing blood from flowing into the aneurysm. Multiple coils are introduced inside the aneurysm till the time no blood flow is seen inside the aneurysm. The procedure prevents rebleeding. In this type of treatment there is no scar over the head and the entire treatment is done through a tiny hole in the groin or wrist. In general, this form of treatment is less risky then open surgery and recovery time is less.

Endovascular flow diversion:

When coiling and clipping are difficult due to the size or shape of the aneurysm, flow diversion can come in handy. A flow-diverter stent is a tightly woven mesh tube and is inserted in the main artery across the aneurysm.
The tight mesh stent prevents easy blood flow into the aneurysm, and blood flows through the artery predominantly with minimal flow inside the aneurysm. Lack of blood supply will cause the aneurysm to form thrombus/clot and it gradually shrink and disappear. The recovery time is usually two to four days in an unruptured aneurysm.

Mechanical Thrombectomy for Ischemic Stroke:

Large blood clots that block large arteries of the brain can be opened by this procedure. In such cases, a minimally invasive procedure, which uses clot retrieval devices to pull out the clot, leaving the artery open, is recommended.

In this procedure like other major neurointervention cases, a small (2-3mm) hole is made into wrist or upper leg and a catheter is inserted in the arterial system. With the help of wire and fluoroscopy the catheter is taken to the site of blockage. Angiography is done to find the exact site and extent of blockage. Then with the help of a modifies stent called Stenreiver, the clot is caught with the device and pulled out from the circulation thereby opening the blocked vessel. Sometimes instead of using a stent a large bore catheter is used to aspirate the clot like vacuum cleaning.

Angioplasty and Stenting

Angioplasty, often known as balloon angioplasty, is a treatment procedure in which the arteries are opened to let the blood flow smoothly without blockages by using a balloon attached at the tip of a long tube called a catheter. It is performed to compress plaque along the side of the wall of the blocked artery. It is also used to treat conditions like coronary artery disease which is blockage of heart arteries known as coronary arteries or in brain arteries called carotid arteries. It allows more blood to get through the narrowed arteries and reduce the risk of stroke. Once the artery is opened a stent is inserted to make it remain open.

Procedure: 

• The patient is prepped for the treatment by giving medications that will prevent blood clots. The surgeon initially inserts catheters through the skin in the affected area into the blood vessels in the wrist/upper leg. 
• X-rays are used to view the movement of the catheters. The catheters are then moved through the blood vessels to reach the affected site. A balloon catheter is then used to remove the plaque responsible for the blockages. 
• When the balloon is inflated, it moves the plaque out of the way and allows the blood to flow smoothly. 
• Then, the surgeon places a metal stent, which is small and hollow tube, which keeps the artery open and prevents blockages. The stent may have a drug coating that prevents the future narrowing of the arteries.

Tumor Embolisation

Embolisation is a minimally invasive procedure that closes or blocks certain blood vessels. It helps eliminate the connections between the arteries and veins or can be used to close the blood vessels supplying certain tumours, and stops excessive bleeding. The tools used for this procedure are as follows:

• Balloons, which block the blood vessels temporarily or permanently
• Gelatine foam, which is a sponge-like material made of gelatine 
• Liquid glue, which hardens quickly to seal the blood vessels
• Liquid sclerosing agent, which destroys abnormal tissues
• Metallic coils made up of steel or platinum 
• Particulate agents, which block small blood vessels 

The procedure is as follows:

• Interventional radiologists, after sedating the patient, make a small puncture or incision in the skin near the wrist or upper leg.
• Then, they insert a catheter through the incision and move it to the affected area.
• Then, fluoroscopy is done to view the treatment area and the instruments.
• Then, a special dye/contrast media is placed through the catheter for enhanced views of the blood vessel and blood flow. 
• The embolic agents are then delivered through specialised micro-catheters to ensure the blood flow stops in the required area.
• Then, the catheter is removed, and the incision is covered with stitches and bandages.

Vertebroplasty

Vertebroplasty is a minimally invasive treatment used to treat certain types of spinal compression fractures, which are the breaks seen in the vertebrae where the broken pieces of bones rub against each other and cause pain. Vertebroplasty involves using surgical cement to hold the pieces of broken bones together to stop the pain. It is usually a day care procedure in which patient lies on their stomach and fine needle is inserted through the back into the fractured vertebra and liquid cement is injected under fluoroscopy. It immediately hardens causing stabilisation of the fracture leading to reduced pain.

How team Fortis helps you during recovery from neurointerventional diseases?

Team Fortis is a group of medical professionals with experienced doctors, advanced medical techniques, and procedures to treat various neurological conditions. They help patients at every stage during the treatment and play a vital role in their recovery. Here are some ways in which they help with various conditions:

Team Fortis offers early intervention for neurological conditions. Rapid diagnosis and early treatments benefit by lowering the risk of complications and enhancing recovery time.

To lower the risk of problems and hasten recovery, the treatments are carried out through tiny incisions. Team Fortis are experts in carrying out these minimally invasive treatments with the help of advanced tools and techniques.

• They consider each patient’s unique needs and treat them accordingly with the best treatment possible for their unique conditions.
• They work in coordination with other healthcare professionals and treat the patients effectively with great care. They work with neurologists, neurosurgeons, and radiologists.
• To precisely diagnose and treat neurointerventional issues, they use modern and advanced imaging and diagnostic techniques and treatments. 
• After the procedures and surgeries, team Fortis offers full post-procedural care, including medication management, pain control, and physical therapies. It benefits the patient by accelerating healing and lowering the chances of complications and risks. 
• Overall, the main aim of team Fortis is to deliver the right treatment and proper care to the patients and enhance their recovery.

Conclusion

All things considered, the fast-developing discipline of neuro-interventional radiology provides minimally invasive therapies for a variety of neurological conditions like stroke, brain aneurysms/AVM’s, lowering the risk of complications and enhancing patient outcomes. As it uses minimally invasive treatments, patients are at less risk, spend less time in the hospital, and recover faster. In this, team Fortis plays a vital role in assisting patients in recovery by offering early intervention, individualised care, collaborations with other specialities, advanced imaging and diagnostic techniques, and post-procedural care.