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Endovascular neurosurgery also called Interventional Neurosurgery is a subspecialty within neurosurgery that uses catheters and radiology to diagnose and treat various conditions and diseases of the central nervous system. Endovascular neurosurgery uses tools that pass through the blood vessels to diagnose and treat diseases and conditions rather than using open surgery.

Technologies & Procedures

Neuroendovascular suite

BRAINS is equipped with a state-of-the-art neuroendovascular suite that comes loaded with a uniplanar digital subtraction angiographic apparatus with rotational 3D angiography to visualize tortuous and intricate neurovascular anatomy.Capable of four-way rotation, the operating table permits wide excursion and pivot rotation. The suite features also roof-mounted equipment, such as video monitors and data storage and picture archiving and communication system (PACS).

The control room with console for operating the angiographic equipmentis spacious enough to accommodate ancillary personnel, medical students and visitors.

Cerebral angiogram

Also known as brain angiogram or digital subtraction angiogram (DSA)this is a study of blood vessels of the brain, which is done commonly through femoral artery puncture in the groin.

Procedure

A catheter is passed through femoral artery and cannulated (introduced) into the carotid artery (arteries that supply the head and neck with oxygenated blood) via the aortic arch. Dye can be injected into the carotid and cerebral blood vessels and these can be studied.Super-selective catheterization of each cerebral vessel can be done using a micro-catheter making it possible to diagnose and treat various diseases of the cerebral vessels.

Endovascular coiling for Aneurysm

This refers to the insertion of platinum coils into the aneurysm. A catheter is inserted into a blood vessel, typically the femoral artery, and passed through blood vessels into the cerebral circulation and the aneurysm. Coils are released into the aneurysm sac. Upon depositing within the aneurysm, the coils expand and initiate a thrombotic reaction within the aneurysm.

Stent assisted coiling

This procedure is done for aneurysm with a wide neck. A stent is placed in the blood vessel at the site of the aneurysm and coils are introduced through the strut of the stent into the aneurysm.

Endovascular Embolization For AVM

Endovascular Embolization can be done by cutting off the blood supply to the AVM with coils, particles or glue introduced by a radiographically guided catheter. Depending uponthe size, site and angio-architectonic features of an AVM, endovascular embolization can be a primary course of treatment or an adjuvant (an add on) to surgical excision or radiosurgery.

Mechanical thrombectomy in acute stroke

Patients with large-artery occlusion and those who are ineligible for fibrinolytic therapy(a process that prevents blood clots from growing) mechanical thrombo-embolectomy can be a better option. Mechanical devices offer theoretical advantages over pharmacological treatment including speed of recanalization, revascularization of large-artery occlusions and reduced risk of hemorrhage and longer window time for use.

Procedure

A mechanical retriever device is passed through a fine catheter via a femoral artery puncture into the occluded (obstructed) vessel in the brain.By crossing the site of occlusion, this corkscrew-shaped device pulls the occlusive thromboembolus into an extracranial guide catheter and completely opens the occluded vessel.

Angioplasty and Stent Revascularization in acute stroke

Angioplasty is now commonly used in stroke revascularization and is occasionally followed by stenting. It has been performed most commonly as a rescue procedure to displace thrombus or following early re-occlusion after successful fibrinolysis (process that prevents clots from growing). Angioplasty with stenting was originally described in acute stroke for underlying atherosclerotic stenosis after successful fibrinolysis. Stenting at the time of acute stroke has been used most frequently in Asia, where intracranial atherosclerotic disease is the most common cause of acute ischemic stroke. Recanalization rates with angioplasty are high with or without accompanying fibrinolysis with good outcome.

Carotid angioplasty and stenting

Carotid angioplasty and stenting is a minimally invasive endovascular procedure, which can be done without surgery. It is performed during an angiogram in an interventional radiology suite. A flexible catheter is advanced from the femoral artery in the groin, past the heart, and to the location of the plaque within the carotid artery. Next, a small catheter with an inflatable balloon at the tip is positioned at the plaque site. When the balloon is inflated it dilates the artery and compresses the plaque against the arterial wall. The balloon is then deflated and removed. Finally, a self-expanding mesh-like tube called a stent is placed over the plaque, holding open the artery.