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Neuroendovascular Surgical Procedures

Stroke survivor Jim Cox Neuro team helps stock car enthusiast get behind the wheel again after a stroke
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During neuroendovascular surgical procedures, an interventional neuroradiologist navigates a microcatheter (thin tube) through the vascular system. The catheter is inserted through a small incision in the groin, and then guided to the affected blood vessels for treatment.
At the University of Chicago Medicine, our team performs neuroendovascular surgical techniques with leading-edge expertise and state-of-the-art equipment, specializing in:

  • Acute stroke intervention, including transcatheter tPA thrombolysis and intracranial mechanical thrombectomy
  • Angioplasty and stenting, for intracranial and carotid artery stenosis
  • Embolization procedures, for cerebral (brain) aneurysm, arteriovenous malformation (AVM), dural arteriovenous malformation/fistula (DAVM/DAVF), spinal AVM/AVF, brain tumors, head and neck tumors, and severe nosebleeds
  • Sclerotherapy, for enlarged blood vessels caused by vascular lesions of the head and neck

Acute Stroke Intervention

In patients with acute ischemic stroke or dural sinus thrombosis, our specialists use the following neurointerventional surgical techniques to remove blood clots, restoring blood flow through blocked vessels as quickly as possible.

Transcatheter tPA thrombolysis

By placing a microcatheter into a blocked brain artery or vein, interventional neuroradiologists are able to inject tissue plasminogen activator (tPA) -- a clot-busting drug -- directly into a blood clot. This technique, sometimes combined with intravenous (IV) tPA, maximizes chances of a good clinical outcome in patients with acute ischemic stroke or dural sinus thrombosis.

Intracranial mechanical thrombectomy

Interventional neuroradiologists use different techniques to remove blood clots from blocked arteries in the brain and dural venous sinuses -- a process known as intracranial mechanical thrombectomy. These techniques require specialized tools, and are sometimes used in combination with transcather tPA thrombolysis. At the University of Chicago Medicine, our team may choose from several blood clot removal devices, including:

  • Merci Retriever, which uses a corkscrew-like mechanism
  • Penumbra, which uses suction force
  • Retrievable stents
  • Catheter and wire (traditional)

» Read more about comprehensive stroke care at the University of Chicago Medicine.

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Angioplasty and Stenting

Intracranial Angioplasty and Stenting

Intracranial angioplasty and stenting are used to restore blood flow through blocked vessels inside of the skull. For angioplasty, the microcatheter is equipped with a tiny balloon on the tip. During the procedure, the catheter is navigated through the blood vessels to the occlusion, where the balloon is inflated to open the blockage. In some cases, a stent is placed to keep the blood vessel open.

Carotid Angioplasty and Stenting

The carotid artery is a main artery on the neck, which delivers blood to the brain. Narrowing or blockage of the carotid artery causes more than 10 percent of acute ischemic strokes in the nation. Carotid angioplasty and stenting is a technique used to open a blocked carotid artery. In this procedure, interventional neuroradiologists insert a microcather through a small incision in the groin and up through the vascular system. Once it reaches the blockage, the balloon is inflated to open the vessel, and the stent is placed to keep it open.

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Embolization Procedures

During embolization procedures, an interventional neuroradiologist uses a microcatheter to place miniature instruments and materials in blood vessels. These materials, called emboli or embolic agents, may include coils, microparticles, glue or foam. Emboli are carefully placed to stop or prevent bleeding in the treatment of:

Coil Embolization for Brain (Cerebral) Aneurysms

Coil embolization, or endovascular coiling, is used to treat a cerebral aneurysm (a bulging or weakened area in the wall of a blood vessel in the brain). In this procedure, a soft metal coil is inserted into the aneurysm, sealing it from within to help prevent it from rupturing.

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Arteriovenous Malformation (AVM) Embolization

Arteriovenous malformations (AVM) are tangled connections between arteries and veins in the brain or spinal cord. Without effective intervention, this abnormality can lead to catastrophic hemorrhagic stroke (brain bleed) and can be fatal. During embolization, an interventional neuroradiologist injects glue into the AVM. The glue immediately hardens and blood flow through the AVM is blocked off, which eliminates the risk of bleeding.

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Dural Arteriovenous Malformation/Fistula (DAVM/DAVF) Embolization

A dural arteriovenous malformation/fistula (DAVM/DAVF) is an abnormal connection between an artery in the dura, which is the outer membrane covering the brain and spinal cord, and a vein in the brain. This abnormality increases blood pressure in the brain to critically high levels, potentially causing a brain bleed that can be fatal. Neuroendovascular embolization usually is the first treatment option for DAVM/DAVF. In this procedure, an interventional neuroradiologist uses a microcather to place glue, microparticles or detachable microcoils in the affected blood vessels. This technique blocks the blood supply to the affected vessels, while sparing normal veins. In the most severe cases, open surgery and radiation therapy may be combined to treat this condition.

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Spinal Arteriovenous Malformation/Fistula (Spinal AVM/AVF) Embolization

A spinal arteriovenous malformation/fistula (spinal AVM/AVF) is an abnormal connection between blood vessels in or near the spine. This condition can cause bleeding or pooling of blood (venous congestion) in or around the spinal cord, possibly leading to significant dysfunction, such as lower extremity weakness or paralysis, sensory changes, and bowel or bladder control issues. Our specialists generally use spinal MRI for diagnosis, and spinal angiography for treatment planning. Endovascular embolization is an effective technique in the treatment of spinal AVM/AVF. It is sometimes effective as the only treatment technique, and sometimes combined with open surgery or radiation therapy for the most comprehensive approach.

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Embolization for Tumors of the Brain, Head and Neck

Using image guidance, an interventional neuroradiologist injects microparticles, glue, gelfoam or coils to block the blood supply to a tumor. This usually is done prior to surgical resection of the tumor in order to reduce blood loss during surgery, shorten operative time and improve chances of complete tumor removal.

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Nosebleeds (Epistaxis) Embolization

Epistaxis embolization is an option when nose bleeding is severe, difficult to locate or does not respond to traditional treatment. During embolization, an interventional neuroradiologist places microparticles, glue, Gelfoam or a coil to stop the bleeding, allowing the vessel to clot and heal.

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Sclerotherapy for Enlarged Blood Vessels Caused by Vascular Lesions of the Head and Neck

Sclerotherapy is a technique used to shrink abnormally enlarged blood vessels visible on the skin of the head and neck. During the procedure, an interventional neuroradiologist injects medicine directly into the affected lesion, under X-ray or ultrasound guidance. The medicine (a sclerosing solution) destroys the lesion, causing it to initially swell before shrinking over time, and redirecting blood to healthier veins. The swelling generally lasts about two to three days, but possibly up to a week. Eventually, the lesion becomes scar tissue and fades away.

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