Treatment Options

Marion Bloch Neuroscience Institute | Neurovascular

Treatment Options

Patients who suffer ischemic strokes need rapid intervention. Luckily, advances in stroke therapies have opened the treatment window, giving Saint Luke's doctors greater opportunities for reversing or minimizing stroke's debilitating effects.

Saint Luke’s doctors can reverse the effects of stroke by removing blockages that prevent normal blood flow to an individual's brain. This technology, called mechanical embolectomy, removes the clot with a mechanical device. Working from a groin artery, doctors use a catheter to maneuver miniature devices through the blood vessels of a patient's brain and remove the blockage.

In many cases, this procedure prevents patients from experiencing such drastic effects of stroke as:

  • Impaired speech
  • Impaired vision
  • Paralysis
  • Memory loss
  • Death

Our team has used embolectomy devices to treat stroke since 2001. As a result, Saint Luke’s team is recognized as being among the best in the world.

Ischemic stroke is caused when blood stops flowing to a region of the brain. Many times the blockage occurs from atherosclerosis of an artery in the neck, shoulder, or upper chest. These blockages are often treated with a neurointerventional stenting procedure.

When the blockage involves a large artery like the carotid, it’s critical that doctors prevent plaque in the artery wall from breaking free and blocking a brain artery. They do this by first placing a tiny filter inside the artery between the atherosclerotic plaque and the brain. In rare cases where a filter cannot be used, it’s possible to reverse flow in the blocked artery to gain control of the plaque. With the brain protected, doctors use an angioplasty balloon to clear the blockage and then implant a stent to help prevent another blockage. 

A brain aneurysm occurs when a portion of an artery wall becomes weakened and forms a pouch. Like an over-stretched balloon, the aneurysm can pop, which creates a blood clot over the surface and deeper in the brain. Doctors treat most aneurysms with an angiogram procedure where, from the inside of the blood vessel, they pack the aneurysm with platinum coils to prevent future bleeding. For aneurysms that cannot be safely coiled, a neurosurgeon will open the skull and place a clip across the aneurysm. 

Fortunately, not all brain aneurysms cause bleeding. Aneurysms discovered on brain scans are usually treated electively by coiling, stenting, or through a new technology called flow diversion using a Pipeline® stent. This therapy implants a mesh tube across the opening of the aneurysm, which effectively diverts blood flow away from the aneurysm sac. Saint Luke’s neurointerventional specialists routinely perform all of these procedures. 

Unlike brain aneurysms that develop in adulthood, malformations of the brain’s blood vessels are congenital. Arteriovenous malformations (AVMs) are the most common serious defects in blood vessels. 

AVMs are tangles of blood vessels within the brain. Because of a combination of weak blood vessel walls and high blood flow through an AVM, this malformation carries a lifelong risk of spontaneous bleeding in the brain. Small AVMs can be treated with focused radiation.  Saint Luke’s neurointerventional specialists typically treat medium to large AVMs by embolizing the abnormal blood vessels. 

During this angiogram procedure, doctors thread a microcatheter from a groin artery to the AVM where they inject the abnormal blood vessels with TruFill® or Onyx®, which are glue-like substances, to close the AVM. Typically, a neurosurgeon removes most AVMs. 

Embolization can also be used to close diseased blood vessels of the head and neck. Neurointerventional specialists treat uncontrolled bleeding of the face, jaw, and nose (epistaxis) with an embolization procedure similar to that of treating an AVM. Sometimes doctors embolize tumors of the head and neck before removing them to shut down blood vessels that might bleed excessively during surgery. 

Neurointerventional specialists also perform such spine procedures as:

  • Myelography, or CT imaging of the spine with contrast
  • Lumbar punctures, or spinal taps
  • Compression fracture treatments 

For compression fractures of the spine caused by osteoporosis or metastatic tumors, doctors can typically relieve patients’ pain by injecting a glue-like material into the vertebra containing the cleft.