One of the most significant advancements in modern medicine is that many diseases, which were previously treatable only through open surgery, can now be successfully treated with a minor vascular intervention. Interventional neuroradiology is an advanced medical discipline that enables the treatment of brain, spinal cord, and neck vascular diseases through catheters under imaging guidance. This method, which means less trauma, shorter hospital stays, and faster recovery for the patient, stands out as a life-saving approach, especially in emergency situations such as stroke, aneurysm, and vascular malformations.
What is Interventional Neuroradiology?
Interventional neuroradiology covers diagnostic and therapeutic procedures performed by accessing brain and neck vessels through thin catheters, usually inserted via the femoral or radial artery, with the aid of digital subtraction angiography (DSA) devices. No skin incision is made; a millimetric vascular entry is sufficient. With this method, many serious neurovascular diseases can be treated, ranging from aneurysms to vascular occlusions, and from arteriovenous malformations to strokes. The discipline works in close cooperation with fields such as neurosurgery, neurology, radiology, and anesthesiology.
Working Principle
The procedure is performed under real-time high-resolution fluoroscopy. Once the catheter, advanced through the vessel, reaches the target area, contrast medium is injected to map the vasculature. Subsequently, treatment is performed using coils, stents, flow diverters, embolization agents, or clot retrieval devices. Throughout this process, the patient's vascular structure is imaged with millimetric precision, allowing even very small lesions to be treated.
Which Diseases Does It Treat?
Interventional neuroradiology is currently the gold standard in the treatment of many critical neurovascular diseases:
- Brain aneurysm: Closing ballooning in the vessel wall with coils or stents
- Acute ischemic stroke: Removal of the clot in the brain vessel via mechanical thrombectomy
- Arteriovenous malformation (AVM): Embolization of abnormal vascular tangles
- Carotid artery stenosis: Opening narrowings in neck vessels with stents
- Dural arteriovenous fistula: Abnormal vascular connections in the meninges
- Tumor embolization: Reducing tumor vascularity prior to surgery
- Spinal vascular pathologies: Spinal cord vascular diseases
- Vascular lesions of the face and neck region
- Subarachnoid hemorrhage: Emergency aneurysm treatment
- Vertebroplasty and kyphoplasty: Treatment of spinal compression fractures
Advantages of Interventional Neuroradiology
Compared to open surgery, interventional neuroradiology offers many significant advantages to the patient:
- Minimally invasive: Only a millimetric vascular entry is sufficient; no open surgery is required.
- Short hospital stay: Most patients are discharged within 1-3 days.
- Rapid recovery: The time to return to daily life is significantly shortened.
- Low complication rate: General anesthesia is not required in every case.
- Hard-to-reach areas: Surgically risky areas can be accessed safely.
- Emergency intervention capability: In acute stroke treatment, minutes save lives.
- Aesthetic result: No scars remain as there is no skin incision.
- High success rate: Highly effective with correct indications.
- Elderly patient compatibility: Can also be applied to patients who are not suitable for open surgery.
How Does the Treatment Process Proceed?
The patient is first evaluated by a neurology, neurosurgery, or neuroradiology specialist. The disease is mapped using imaging tests such as MRI and CT angiography. After the treatment plan is finalized in a multidisciplinary council, the patient is prepared for the procedure. Blood tests, ECG, and necessary consultations are completed. The patient and their relatives are informed in detail about the procedure details, expected outcomes, and potential risks.
Procedure Phase
The procedure is performed in the angiography unit under local or general anesthesia. The catheter, inserted through the femoral or radial artery, is advanced to the target vessel. Depending on the type of treatment, a coil is placed, a stent is deployed, a clot is removed, or embolization is performed. Although the duration varies depending on the procedure, it takes an average of 1-3 hours. In acute stroke cases, interventions are initiated within minutes, acting on the principle that "time is brain."
Post-Procedure Process
The patient is monitored for 24 hours in the intensive care unit or a ward room. The vascular entry site is checked, and the neurological examination is repeated. Most patients can stand up and return to normal nutrition in a short time. Treatment success is objectively evaluated with follow-up imaging.
Points to Consider
Some important points must be considered before and after the procedure:
- Blood-thinning medications used must be reported to the physician.
- A history of contrast medium allergy must be questioned in advance.
- Kidney function tests should be checked before the procedure.
- High fluid intake is recommended after the procedure.
- A physician should be consulted in case of swelling, bruising, or pain at the vascular entry site.
- Follow-up imaging should not be delayed.
- Diabetic patients should temporarily discontinue metformin-group medications.
- Recommended antiplatelet therapy should be used regularly.
- Any suspicion of pregnancy must be reported in advance.
Interventional Neuroradiology in Acute Stroke Treatment
Acute ischemic stroke is an emergency condition that develops as a result of a clot blocking one of the brain vessels and can lead to permanent damage within minutes. The interventional treatment method called mechanical thrombectomy allows for the mechanical removal of the clot causing the blockage using special catheters and stent retrievers. When applied within the first six hours, the chance of the patient recovering without disability increases significantly. In some selected cases, effective results are obtained even up to 24 hours. Therefore, it is of vital importance that patients with suspected stroke are immediately transported to a well-equipped center.
Modern Approaches in Aneurysm Treatment
Brain aneurysms are balloonings in the vessel wall that can lead to life-threatening subarachnoid hemorrhages if they rupture. As an alternative to the traditional open surgical clipping method, endovascular coil embolization, balloon-assisted coiling, stent-assisted coiling, and flow-diverter stent applications are widely used today. The appropriate treatment method is determined in a multidisciplinary council based on the size, location, and shape of the aneurysm. Flow-diverter stents provide revolutionary results, especially in large and complex aneurysms.
As Koru Hospital, we provide pioneering services in the modern treatment of cerebrovascular diseases with our experienced specialist staff in the field of interventional neuroradiology, state-of-the-art digital subtraction angiography devices, and hybrid operating room infrastructure. From emergency stroke intervention to planned aneurysm treatments, we consider it our duty to offer our patients the safest and most effective treatment options with our multidisciplinary team approach. Thanks to our emergency neuroradiology team serving twenty-four hours a day, seven days a week, we perform life-saving interventions on time in situations where time is racing against us, such as stroke; we are honored to be by your side to protect your brain health with treatment plans tailored to the individual needs of each of our patients.
