Speed, precision and expertise are essential to diagnose and treat vascular diseases of the brain. Now, thanks to the emergence of a new specialty called neurointerventional medicine, many aneurysms, strokes and other cerebrovascular disorders can be treated from the inside out, by delivering tools or medicine to repair the injured site through the natural pathways of the blood vessels rather than with a surgeon’s scalpel.
“An unruptured aneurysm is a potential bomb in your brain,” says UCI Medical Center’s Dr. Varoujan Kostanian. He is one of fewer than 300 certified neurointerventionalists in the country, a specialty that combines neuroradiology with neurosurgery. “We get to the aneurysm effectively and safely, without cutting through the skull. Patients leave the hospital sooner, recover faster and have a better chance for survival.”
An aneurysm is a weakened, bulging section of a blood vessel. If it ruptures, the vessel bleeds into the brain and may cause brain damage, paralysis, coma or death. It is estimated that 18 million people worldwide harbor incidental, unruptured aneurysms.
At UCI Medical Center in Orange, one of the few hospitals in Southern California offering neurointerventional treatments, Kostanian treats vascular disease in the brain by inserting a catheter – a long, flexible tube – into an artery in the patient’s groin. Guided by a two-dimensional angiogram or other sophisticated radiological imaging, Kostanian follows the roadmap of the body’s blood vessels, threading progressively thinner catheters, some barely wider than a hair, through the arteries to reach the vulnerable area.
For aneurysms, he performs endovascular coil embolization, implanting tiny platinum coils in the balloon-like bulge, prompting the body to form scar tissue and seal off the weakened area. He may also implant stents, tiny mesh tubes that fit inside the vessel, to reinforce the walls of the blood vessel.
The alternative to coil embolization is craniotomy – cutting through the skull and placing a clip on the damaged vessel to stop blood flow. An international study last year concluded that aneurysm patients treated with minimally invasive coils had a 23 percent better chance of surviving free of disability, compared to those who underwent clipping.
In patients with stroke, Kostanian uses catheters to deliver clot-dissolving drugs directly to a blood vessel in the brain, or he can remove the clot. These procedures must be performed within six hours after onset of the stroke in order to “localize the damage to the smallest area possible,” he says.
New technology continually is producing better coils, smaller catheters and improved devices, says Kostanian. “The future is very promising and exciting. With better products, we should be able to do more with neurointervention. Everything is changing very rapidly.”
