Neuroradiology

In addition to new medications and surgical techniques, Halifax Health is pioneering a number of new interventional neuroradiologic procedures to prevent stroke in patients with selected high-risk AVMs, aneurysms, and partially blocked arteries.

Halifax Health has the only Interventional neuroradiologists in the area and four neuroradiologists on staff. Interventional neuroradiologic therapies are accomplished endovascularly through microcatheters inserted in the groin area and, under X-ray guidance, threaded through the blood vessels leading into the brain. Interventional neuroradiologists currently employ minimally invasive procedures to accomplish a wide variety of treatments including stroke treatment by delivering clot-busting drugs directly to the site of the blockage; aneurysm therapy by inserting platinum coils into the aneurysm bulge to prevent clotting and rupture; and spinal treatments by injecting cement into a fractured vertebra in order to reinforce the bone.

As compared to surgery, endovascular treatments often involve less risk and result in less pain and a faster recovery period.

Endovascular Treatment of Aneurysms

Halifax Health is the only local choice for patients who have discovered that they have a brain aneurysm. We use the least invasive, most progressive techniques used to prevent aneurysms from rupturing. One such technique is endovascular coiling instead of surgery. Endovascular treatment of brain aneurysms involves insertion of a catheter (small plastic tube) into the femoral artery in the patient’s leg and navigating it through the vascular system, into the head and into the aneurysm. Tiny platinum coils are threaded through the catheter and deployed into the aneurysm, blocking blood flow into the aneurysm and preventing rupture.

According to a national study, there is compelling evidence that, if medically possible, all patients with ruptured brain aneurysms should receive an endovascular consultation as part of the protocol for the treatment.

Here are some of the findings:

• The relative risk of death or significant disability at one year for patients treated with coils was 22.6 percent lower than in surgically-treated patients Average hospital stays are more than twice as long with surgery as compared to endovascular coiling treatment
• Four times as many surgical patients report new symptoms or disability after treatment as compared to coiled patients
• There can be a dramatic difference in recovery times. One study showed that surgically-treated patients had an average recovery time of one year compared to coiled patients who recovered in 27 days.

It is important to note that Halifax Health neurosurgeons evaluate every patient with a cerebral aneurysm and in conjunction with the neuroradiologists to select the most suitable treatment for that patient. These may involve either surgical treatment or endovascular coiling (not every aneurysm is a candidate for coiling and usually not all of the aneurysms can be completely coiled).

Endovascular Treatment of AVMs

Endovascular treatment of AVMs is also available at Halifax Health. One innovative form of treatment involves use of a “super glue” substance introduced via a tiny catheter to reduce the size of the AVM and facilitate further microsurgical or radiation treatment. In some cases, it is possible to completely block off and cure the AVM with endovascular treatment alone.

Angioplasty and Stenting of Vessels in the Neck and Brain

Angioplasty and stenting of vessels in the neck and brain are other new endovascular procedures. Cerebral angioplasty is similar to a widely used cardiology procedure, and is used to open partially blocked vertebral and carotid arteries in the neck, as well as blood vessels within the brain. Stenting of carotid or vertebral arteries and large cerebral veins involves use of a fine, tubular wire mesh to hold the vessel open.

Endovascular Blood Clot Removal

The Merci Retrieval System™ is designed to restore blood flow in large vessel ischemic strokes though a minimally invasive procedure. Once the location of the clot has been identified using angiography, the Merci Balloon Guide Catheter is inserted through a small incision in the femoral artery in the groin. Under x-ray guidance, the Merci Balloon Guide Catheter is maneuvered up to the carotid artery in the neck, a guidewire and the Merci Microcatheter are deployed through the Balloon Guide Catheter and then placed just beyond the clot. The physician then deploys the Merci Retriever device to engage and ensnare the clot. Once the clot is captured, the Merci Balloon Guide Catheter is inflated to temporarily arrest forward flow while the clot is being withdrawn. The clot is pulled into the Merci Balloon Guide Catheter and completely out of the body. The balloon is then deflated, and blood flow is restored.