Neurointerventional procedures utilize minimally invasive techniques, imaging guidance, and special microcatheters (thin tubes), guide wires, and small instruments to treat stroke and other neurological disorders. Neurointerventional procedures are endovascular procedures, which take place inside blood vessels. At The Valley Hospital, our neurointerventional procedures are performed by specially trained neurosurgeons and neurologists in a state-of-the-art neurointerventional suite. In many cases a neurointerventional procedure replaces the need for extensive neurosurgery.
The Cerebral Angiogram
Located within our neurointerventional suite is our state-of-the-art biplane angiography system, the first in Bergen and Passaic counties. Our neurosurgeons, assisted by specially trained nurses, use the biplane system to produce diagnostic cerebral angiograms and perform neurointerventional procedures. All patients undergoing neurointerventional procedures first undergo a diagnostic angiogram. During this test, a small catheter is inserted into the femoral artery in the patient’s groin area. The catheter is then threaded up into the aorta and then into the vessels of the neck. The biplane system produces highly detailed three-dimensional views of blood vessels leading to the brain and inside the brain and their relationship to the tissues of the head and neck. The images are produced simultaneously from two regions of the patient’s head, from front to back and from side to side. This reduces the amount of contrast material required, improves visualization for diagnostic and therapeutic procedures, and shortens the time it takes to complete the angiogram.
Our Neurointerventional Procedures
At Valley, our neurosurgeons researched and pioneered several neurointerventional devices and procedures used to treat strokes:
A MERCI retrieval procedure may be used to treat an embolic/ischemic stroke, one in which a blood clot has blocked blood flow and oxygen to the brain. During this procedure, a neurosurgeon threads a coil into the femoral artery in the patient’s groin and then moves it up to the blood vessel in the brain that contains the blood clot. A corkscrew device called MERCI grabs the clot and removes it, freeing up blood to once again pass through the blood vessel. Once the procedure is over, the patient is brought to our Neuroscience ICU for continued care and monitoring.
Also used to treat an embolic/ischemic stroke, the Penumbra device is similar to a MERCI device, but Penumbra breaks up the clot inside the blood vessel and then suctions it out in pieces.
If a patient has suffered a hemorrhagic stroke, in which a blood vessel balloons (aneurysm) or ruptures, causing leakage of blood into the brain, an endovascular coil procedure may be used to block blood flow to the aneurysm. During this procedure, a neurosurgeon threads a catheter containing slivers of metal up from the femoral artery into the aneurysm, packing the area with the metal to stop the leakage.
If a patient’s stroke occurs as a result of a rupture of an arteriovenous malformation (AVM), a tangle of faulty arteries inside the brain, treatment may include neurosurgery or a neurointerventional procedure that uses an adhesive substance to block blood flow from the AVM into the brain.
Following neurointerventional procedures, patients are cared for and monitored in our Neuroscience ICU, a specialized inpatient unit staffed by neurologists, neurosurgeons, advanced practice neurological nurses, and registered nurses, all of whom are trained in critical care, advanced life support, and advanced cardiac life support. Many of our nurses have also attained national certification in critical care or neurological nursing.