For patients, the benefits of neurointerventional surgery (also commonly known as interventional neuroradiology) include smaller incisions, less risk, faster recovery and less pain than traditional surgery. Our team provides neurointerventional surgical care for many conditions that previously were untreatable or required more invasive, open surgical techniques.
Neuroendovascular Surgical Procedures
In patients with acute ischemic stroke or dural sinus thrombosis, our specialists use several 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 UChicago Medicine, our team may choose from several blood clot removal devices, including:
- Catheter and wire (traditional)
- Merci Retriever, which uses a corkscrew-like mechanism
- Penumbra, which uses suction force
- Retrievable stents
Intracranial Angioplasty & 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 where the balloon is inflated to open the blockage. In some cases, a stent is placed to keep the blood vessel open.
Carotid Angioplasty & 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 microcatheter 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.
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.
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.
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.
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 microcatheter 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.
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.
Embolization for Tumors of the Brain, Head & 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 removal of the tumor in order to reduce blood loss during surgery, shorten operative time and improve chances of complete tumor removal.
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.
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 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.
Minimally Invasive Surgery for Spinal Fractures
Our neurointerventional surgery team also specializes in vertebroplasty and kyphoplasty for minimally invasive surgical treatment of compression fractures in the spine.
Neurointerventional Surgery for Spinal Fractures
At UChicago Medicine, our interventional neuroradiologists specialize in highly effective, minimally invasive techniques for the treatment of spinal fractures.
Vertebroplasty & Kyphoplasty
Vertebroplasty and kyphoplasty are neurointerventional surgical procedures used to treat compression fractures (collapsed vertebra) in the spine and related back pain. During these minimally invasive surgical procedures, a needle is inserted through the back muscle and into the affected bone. In most cases, the patient experiences pain relief almost immediately. Most patients are released for discharge within two to three hours.
- In vertebroplasty, an interventional neuroradiologist injects a medical cement mixture into the bone to make it more stable.
- In kyphoplasty, an interventional neuroradiologist inflates a balloon within the bone to add more space, and then fills the expanded space with medical cement.
Both procedures are generally effective in stabilizing the spine and reducing or stopping back pain. Interventional neuroradiologists determine which technique to use based on the location and severity of the collapsed vertebra(e).