Neurointervention is a subspecialty of neurology that uses minimally invasive endovascular procedures to diagnose and treat various neurological conditions. These procedures are performed by interventional neuroradiologists in conjunction with neurologists. Some of the most common procedures performed include:
Stroke Treatment
One of the main focuses of Interventional Neurology is the treatment of acute ischemic strokes. Ischemic strokes occur when a blood clot blocks an artery in the brain, preventing blood flow and oxygen delivery to brain tissue. Neurointervention procedures aim to restore blood flow as quickly as possible to minimize brain damage.
Endovascular thrombectomy is a procedure used to remove large clots from the brain’s major arteries. A catheter is inserted through an artery in the groin and guided up to the blocked vessel using imaging such as angiography. A stent retriever or other clot retrieval device is then deployed to capture and extract the clot. Removing the clot within 24 hours of symptom onset can significantly improve patient outcomes and reduce long-term disability from a major stroke.
Intracranial Stenosis Treatment
Cerebral angioplasty and stenting is used to treat intracranial stenosis, a narrowing of the arteries within the brain. This narrowing reduces blood flow and can lead to transient ischemic attacks (TIAs) or recurrent small strokes. During the procedure, a catheter with a balloon and stent is advanced through the groin artery up to the site of stenosis. The balloon is inflated to widen the narrowing and a stent is deployed to keep the artery propped open long-term. This improves blood flow to the brain and reduces future clot formation.
Brain Aneurysm Treatment
An intracranial aneurysm is a bulge or balloon-like swelling in the wall of an artery in the brain. Interventional neurology procedures are commonly used as alternatives to open surgery for repairing brain aneurysms.
Coiling involves using a catheter to deliver wire coils into the aneurysm sac. As more coils are placed, they promote clotting inside the aneurysm and block blood flow into it. Over time, new cell growth forms over the coils, sealing off the aneurysm from the parent artery. This minimally invasive approach reduces pressure on the aneurysm wall and risk of rupture.
Flow diversion uses a self-expanding stent with endoframe meshwork placed across the aneurysm neck. The tightly woven metal diverts blood flow away from the bulge, causing it to gradually shrink and close off from the artery. This approach is good for giant or complex aneurysms otherwise considered high-risk for surgical clipping.
AVM Treatment
An arteriovenous malformation (AVM) is an abnormal connection between arteries and veins that bypasses the normal capillary bed. This can cause life-threatening bleeding into the brain. Interventional Neurology can offer treatments to eliminate these tangles of abnormal vessels.
Embolization is often the first-line treatment for AVMs, using detachable coils or liquid embolic agents delivered through a catheter. The goal is to partially or completely block the shunt points between arteries and veins, reducing blood flow and pressure within the AVM. This makes it safer to be treated later with stereotactic radiosurgery or microsurgery. Sometimes embolization can eliminate the AVM entirely in one session.
Spinal and Cerebral Angiography
Catheter angiography provides real-time imaging of the brain’s blood vessels. A catheter is inserted into an artery, usually in the groin, and advanced up to the arteries supplying the brain. Radiocontrast dye is injected, allowing live X-ray fluoroscopy to visualize the vessels on a monitor. This allows precise visualization of abnormalities like aneurysms, AVMs, or stenosis. Angiography helps accurately diagnose these conditions and guide endovascular treatments. It can also be used as a diagnostic tool to evaluate vascular diseases causing headaches or seizures.
Outcomes and Benefits of Interventional Neurology
Advances in endovascular techniques have vastly improved treatment options and patient outcomes for many formerly surgically difficult neurological conditions. Minimally invasive procedures tend to have shorter recovery times than traditional open surgery, leading to reduced hospital stays. Studies have shown improved outcomes for endovascular stroke treatment compared to intravenous thrombolysis alone, with higher recanalization rates and independence at 90 days. Coiling and flow diversion achieve superior aneurysm occlusion rates versus clipping, with lower complication risks. Ongoing research continues refining these methods to maximize benefits. Interventional Neurology represents an important therapeutic frontier in modern neuroscience.
Risks and Limitations
As with any medical procedure, there are risks from endovascular neurology interventions including infection, aneurysm regrowth after coiling, recurrence of stenosis, and vascular injury or rupture. Rare but serious complications can include embolic stroke from catheter manipulation. Patient selection is important, as some complex aneurysms or AVMs remain better treated with microsurgery. Endovascular techniques also have steep learning curves for operators to achieve high technical success rates. Continued research aims to minimize complication risks through better devices, imaging guidance and operator training. Overall benefits still outweigh risks for properly indicated cases.
Summary
In summary, the field of Interventional Neurology utilizes minimally invasive catheter-based procedures to treat a wide array of neurological conditions from acute stroke to complex vascular malformations. Endovascular techniques provide definitive treatment alternatives or adjuncts to surgery with generally faster recovery times compared to open procedures. Ongoing advances continue pushing the
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1. Source: Coherent Market Insights, Public sources, Desk research
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