Memorial HealthWatch Winter 2008
Interventional Medicine for AVM and Strokes
Minimally Invasive Surgical Techniques Offer Less Risk, Less Pain and Faster Recovery Time
The idea of being in danger of having an aneurysm, a stroke or any similar lifethreatening neurovascular condition is scary, to say the least—especially to anyone in fragile health, which might make surgery too risky. Thanks to modern technological advances and a staff of highly trained specialists, Memorial Healthcare System offers a range of potential solutions through new, innovative, interventional procedures. "Interventional medicine gives us a world of opportunity for safer treatment," says Hoang Duong, MD, Memorial's Director of Interventional Neuroradiology. "It can be crucial for our elderly patients and for anyone who has a severe condition that would otherwise be difficult to treat."
AVM (Arteriovenous Malformation)
One diagnosis that requires immediate treatment is arteriovenous malformation (AVM), a tangle of abnormally connecting arteries and veins that occurs inside the brain. Memorial offers an alternative approach to surgery called endovascular embolization, a relatively new procedure in which the AVM is blocked off rather than removed so that blood no longer flows through it. This dramatically minimizes the risk to patient and allows for a more rapid recovery because it's performed without cutting into the skull. Instead, a micro-fine catheter is inserted into an artery through a small incision in the groin area, then guided through the blood vessels to the AVM. It then seals off the AVM with surgical glue, metal coils or other materials, leaving the surrounding tissue undisturbed. Advantages include lower risk, cost and recovery time.
Carotid artery stenting (CAS) is a strokeprevention procedure that is done in one hour under twilight anesthesia on patients who are at high risk for surgery. It entails making a small incision in the groin area and inserting a small catheter into the carotid artery; the doctor then inserts a stent that keeps the artery open. "We can communicate with patients while we're doing it and ask them to perform tasks that help us monitor their neurological status," says Laszlo Miskolczi, MD, an interventional neurologist with Memorial. Memorial Regional Hospital is one of a few hospitals in the state using special filters that capture dislodged plaque particles during CAS, adding an unprecedented measure of protection to the patient.
"The results of carotid artery stenting appear to be as good as surgery. We think most people will receive stenting as primary treatment when ongoing clinical trials comparing carotid stenting with carotid endarterectomy are completed," says Greg Zorman, MD, Chief of Neurosurgery at the Memorial Neuroscience Center. Dr. Zorman believes more patients will request this procedure because it requires no incision in the neck, recovery is quicker and there is little discomfort.