Traditionally, Radiology has been a specialty directed primarily at the diagnostic end of the practice of medicine. In the past one and half decade, a new field has been emerging which has been called Interventional Neuroradiology. Interventional Neuroradiology is a minimally invasive approach in the treatment of vascular diseases of the central nervous system. Interventional neuroradiology is a new but growing specialty primarily dedicated to the treatment of disorders of the blood vessels of the brain, spine, head and neck from inside those blood vessels (an endovascular approach). Using catheters and micro catheter techniques, an interventional Neuroradiologist can reduce or eliminate blood flow to abnormal structures such as aneurysms or vascular formations, but he can also use endovascular techniques to increase blood flow to normal blood vessels that are obstructed by clot or atherosclerotic disease. Advances in the computer technology that provides the images used to guide catheters and other devices within the body, as well as advances in the devices themselves, account for the phenomenal growth of this field.

A growing number of patients with diseases or disorders of the blood vessels of the neck, head and spine can be treated safely and effectively using devices within the blood vessels (endovascular). Common endovascular therapies include angioplasty (opening a narrowed artery with a balloon) and treatment of aneurysms (a balloon-like weakness in the wall of an artery) within the head. Many vascular problems are complicated and require different combinations of medical, surgical, and endovascular treatment for the best outcome. Our goal is to offer the patient the most effective treatment with the lowest risk. In some cases, this may be no treatment at all. In addition to vascular disease, we offer other percutaneous (through small skin punctures) interventions related to the head, neck, spine, and nervous system. These include injections of anesthetics and steroids for relief of pain from nerve root inflammation and image-guided biopsies to obtain diagnoses. Patients with known or suspected disorders of the cerebral vasculature are usually evaluated in close consultation with members of the Departments of Neurology and Neurological Surgery or the Section of Vascular Surgery.

Aneurysms are weaknesses in the wall of an artery that may rupture (burst) if not treated. A ruptured aneurysm may be fatal, however, not all aneurysms need to be treated and not all aneurysms should be treated from within the blood vessels. A variety of options are available for endovascular treatment including filling the aneurysm with soft platinum coils (GDC, Guglielmi Detachable Coils) and blocking the artery from which the aneurysm arises with a variety of different devices.

AVMs are abnormalities of the arteries and veins in which a direct connection, or short circuit, exists between the arteries and veins. Most are congenital, meaning patients are born with this connection. Symptoms of headaches, seizures, or bleeding do not usually appear until the 3rd or 4th decade of life. Rarely are infants or small children found to have an AVM. Surgery, radiation, and endovascular treatment are complementary techniques used for the treatment of these lesions. These abnormal vessels can be blocked with different materials injected through catheters (tubes) placed through the blood vessels into the lesion.

CCFs are an uncommon but unique subgroup of AVM which are primarily acquired later in life than AVMs. They can be separated into direct connections between the carotid artery and the veins of the cavernous sinus (usually due to trauma) or indirect connections in which small arterial branches supply the veins. Both types can be treated very effectively with different endovascular devices.

Atherosclerotic disease or hardening of the arteries can cause severe narrowing (stenosis) of the arteries of the neck and brain. Sometimes these narrowings may cause a stroke (permanent damage to the brain from lack of blood supply) or temporary symptoms of a stroke. This can be from particles of a blood clot or plaque breaking free from the narrowing or from a reduction in the flow through the vessel because of the narrowing. In some patients, these narrowings can be opened using balloons inside the blood vessel. Sometimes we place metal tubes called stents in the vessel to help keep it open.

Most strokes are caused by blood clots lodging in the arteries of the brain. These blood clots come from the heart or from atherosclerotic plaque in the vessels anywhere from the heart to the brain. If the blood clot blocks the artery for long enough, the brain cells ordinarily supplied by that artery die from lack of oxygen and nutrients. In some patients, the blockage can be dissolved using powerful blood clot-dissolving drugs given at the surface of the clot through small tubes.

Patients with certain vascular tumors of the brain, head, neck or spine undergo embolization before surgery. Embolization refers to the blockage of arterial supply using small particles through a small catheter (tube). The advantages of embolization are that blood loss during surgery can be reduced, making surgery safer, faster, and potentially allowing a more complete removal of the tumor.

When an aneurysm ruptures, the bleeding over the surface of the brain sets in motion a cascade of chemical events that results in severe narrowing of the arteries of the brain several days after the rupture. This narrowing may be so severe that medical treatment to keep enough flow through the vessel may fail. In these patients we can often open their arteries by directly administering different drugs and using balloons to dilate the vessels.

Arteriovenous malformations (AVMs) and vascular tumors often involve the spine or spinal cord. Endovascular techniques may be used prior to surgical treatment or as the sole treatment of these lesions. In addition, we also perform a variety of non-vascular procedures in the spine. These include biopsies, nerve root injections for pain relief, and diagnostic discograms.

An angiography is an examination to evaluate blood vessels in the head, neck, brain, or spine that provides an accuracy and quality of resolution better than any other imaging technique at this time. Using local anesthesia, a catheter is placed in an artery in the groin and then directed to the vessels to be examined. Once the catheter is in position, a contrast agent ("dye") is injected which makes the selected blood vessels visible on X-ray. The procedure typically lasts about an hour. Spinal Angiography, however, is done under general anesthesia and lasts about 2 hours.

A tiny hollow tube, called a catheter is installed in an artery in the groin. The catheter is threaded through the circulatory system to the brain. It is then guided to the precise site with the aid of a TV monitor, displaying an X-ray image to the neuroradiologist. Through the microcatheter coils, glue or partides are introduced into the cerebral vessel at the precise site. After the procedure, the catheter is then withdrawn. The procedures are usually done under General Anaesthesia and sometimes under I.V. sedation. INR services work in close collaboration with both cerebro vascular neurosurgery and stroke neurology groups so that patients are given full consideration of the therapeutic options before a treatment recommendation is made.

Endovascular treatment for cerebrovascular disease has undergone major development over last 25 years, Common problems our experts treat include:

Coil Embolization of intracranial aneurysms( ruptured & non- ruptured)
Embolization for Carotid cavernous fistulas.
Embolization for dural arterio-venous fistulas.
Embolization of intracranial & spinal AVM
Supra-aortic arterial balloon angioplasty & stenting procedures.
Papaverine infusion/nimodipine, infusion/balloon angiography for SAH induced vasospasm.
Pre-operative embolization for intracranial tumors.
Intracranial thrombolysis for acute stroke and dural venous sinus thrombosis.
Vertebroplasty
Spinal DSA
Cerebral DSA Intracranial angioplasty & stenting. Balloon Test occlusions. Permanent occlusions of cerebral vessels for fusiform aneurysms