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Neurointerventionologist Removes a Brain Embolus with a Catheter

Posted Dec 18 2009 12:00am

You may have heard about interventional radiologists. They are adept at guiding catheters to various organ sites via arteries and veins and then repairing damage or delivering doses of drugs locally. You can review the list of common IR procedures in the Wikipedia description of the field. One of the challenges for interventional radiologists is that some of them may lack the broad clinical training necessary to treat acutely ill patients. I have always assumed that some of these  procedures would shift to clinicians who receive special training in catheter work. I recently uncovered an article about a neurointerventionologist (neurointerventionist?) who is well known for extracting cerebral emboli in acutely ill stroke patients (see: Neurologist performs catheter procedure on stroke patient). Below is an excerpt from it:
Bobbie Laird was suffering a life-threatening stroke triggered by a blood clot in her brain that was nearly half an inch long. But Dr. John Whapham of Loyola University Health System was able to stop the stroke in its tracks by using a catheter...that busted up the clot and suctioned the debris....When Laird arrived by ambulance at Loyola's emergency room, she was paralyzed on the left side of her body....A clot had traveled from her heart and lodged in her right middle cerebral artery, which supplies blood to most of the right side of her brain. As blood backed up behind the clot and congealed, the clot grew to 10 to 12 millimeters long....[She] was treated with tPA, an intravenous clot-busting drug....There was a slight improvement ...but the improvement was temporary....[Neuroenterventionist] Whapham inserted a catheter device called Penumbra in an artery in the groin. Whapham guided the device up through the heart and carotid artery into the brain. He deployed a tiny agitator, which broke up the clot, then suctioned the debris through a thin tube. Blood flow was restored to the right side of the brain, which controls the left side of the body....Whapham has done similar procedures on hundreds of stroke patients. He has to work fast, because each passing minute increases the chance of permanent damage. But he also has to be careful not to perforate a vessel in the brain, which could be fatal. "It is a very high stakes procedure," he said.

Describing the threading of a catheter into a cerebral artery of a patient paralyzed by an embolic stroke as "high stakes" could be called an understatement. Nevertheless, one must be impressed by the range of technology, skill, and sangfroid that comes into play in such a procedure. There is no question in my mind that many of today's surgical procedures will rapidly shift to an endovascular approach. One of the most impressive is the use of endovascular stent grafts for treating abdominal and thoracic aortic aneurysms. There has been a competition between cardiologists and vascular surgeons about which set of specialists are most qualified to perform this procedure. The former are expanding their scope of practice by calling themselves cardiovascular specialists.

I have been told that many neurosurgeons are now learning how to thrombose berry aneurysms in-situ using neurocatheterization because the surgical approach for this lesion is falling into disfavor. Because of the delicacy of brain tissue and the difficulties of surgical approaches and tissue manipulation, interventional neurology would seem to have a bright future. The article above can only provide added impetus to this change.

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