KING EDWARD MEMORIAL HOSPITAL

Seth Gordhandas Sunderdas Medical College

Acharya Donde Marg, Parel,
Mumbai 400 012. India.
Tel.: 91-22-2410 7000 Fax: 91-22-2414 3435

When You Have a Patient With a Stroke .. Think of …. Interventional NeuroRadiology

(This information is for the use of medical community only. Patients are cautioned that all details of procedure and results are not given in these notes and they should be cautious in drawing conclusions based on this. In case you have queries please contact us at the telephone numbers given at the end of this note.)
The past couple of years have seen tremendous changes in the management of stroke. The traditional methods of treatment .. the so called – conservative management is giving way to more aggression interventional endovasular methods. Of course , the traditional age old surgical techniques still have a place , but in many cases they are being supplemented by or sometimes even replaced by interventional techniques. Yet in other areas, where no aggressive treatment modalities were available, new endovasular techniques have appeared.

All these techniques are being actively practiced in this department, which, overall, probably has the largest experience with interventional neuroradiological techniques in this country.

Following is a broad over view of the interventional techniques that are available at this department. It is important to note that not all patients can be treated with these techniques and each patient will be evaluated on a case by case basis and treatment tailor made depending upon the clinical status – often in consultation with our colleagues in neurosurgery and critical care departments.

Occlusive Diseases of the Cranio-Cerebral Vessels :

Angioplasty and stenting can be performed in suitable cases. Symptomatic, short-segment narrowings in the carotid, subclavian or vertebral vessels are most suitable for this treatment. Both atherosclerotic and non atherosclerotic diseases can be treated this way. For atherosclerotic narrowings in and around the common carotid bifurcation, angioplasty and stenting can be performed on patients who fulfill the NASCET criteria.

For acute intracranial occlusive (embolic) disease involving the carotid territory, intra arterial thrombolysis is possible if the cases reach the hospital within 3 hours. However, this window is increased to 24 hours if the acute occlusive disease is in the vertebro- basilar territory. Here again cases will be carefully screened and only those who fulfill other physiologic criteria will be considered for treatment.

Venous thrombosis in the cerebral veins and venous sinuses is a rather common problem in our country. The traditional treatment modalities generally have a poor outcome in patients who are seriously ill. Direct infusion of thrombolytic agents in the dural venous sinuses helps to salvage a proportion of these patients.

Intracranial Hemorrhage:

Hemorrhage of non hypertensive origin is often due to aneurysms and sometimes due to arterio-venous malformation. Selected patients with intracranial aneurysms , especially those that have a high surgical morbidity can be treated with endovasular �coiling� technique using the GDC system.

Intra arterial embolisation with acrylic glue is used for the treatment of arterio venous malformation either to primarily obliterate them or more often as a prelude to surgery or gamma knife treatment.

For more information or if you have any questions please contact:
Dr. Uday Limaye ,Dr. Manish Shrivastava or Dr. Ravi Ramakantan
Ph : 2410 7000
Extn: 2539.
Fax: 24185678.

E mail : websitecontact@kem.edu

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