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Clinical Neurovascular Program |
| The Mission of the cerebrovascular division at MCG is to promote the education, diagnosis and treatment of patients with a variety of cerebrovascular disorders. Our division consists of a cerebrovascular neurosurgeon trained in both open vascular and endovascular techniques and an interventional neuroradiologist. These two individuals work closely together while treating these patients. The division has a cost center that is separate from both neurosurgery and radiology, and the clinics for these two specialists are conducted at the same time and in |
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Angiograms over time of a typical aneurysm being treated via coil implementation
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Cerebral Arteriovenous Malformations Cerebral AVMs are vascular anomalies consisting of fistulous connections between arteries and veins without a normal intervening capillary bed. Most of these lesions are considered congenital and they typically present by age 40. The most common presentation is intracranial hemorrhage (65%), followed by seizures (15-35%), headaches (15%), and focal neurological deficits (less than 10% of cases). The rupture rate is 3-4% per year. The treatment options include surgical resection, embolization, stereotactic radiosurgery or a combination, but the decision to treat is often a complex one which factors in the age and health of the patient, presentation, characteristics of the lesion, |
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| and treatment risks. |
Photo of arteriovenous fistula case at MCG,
2005 |
| Carotid Stenosis While asymptomatic carotid stenosis carries a low annual risk of ipsilateral stroke of approximately 2%, the 2-year risk of stroke in patients with greater than 70% symptomatic stenosis is 21%. When the plaque is ulcerated this risk steadily |
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increases with increasing degrees of stenosis such that a 75%
symptomatic stenosis with an ulcerated plaque carries a 26.3% 2-year
risk of stroke while a 95% stenotic lesion carries a 73% risk. The
options for treatment include carotid endarterectomy and stenting with
distal protection. While endarterectomy is the most frequently
performed technique, stenting is often the preferred treatment in
patients with a high surgical risk such as those with contralateral
occlusion, previous neck surgery, or previous radiation treatment. Stroke The approval by the NIH of the thrombolytic tPA greater expanded the treatment options for patients presenting with stroke. The NINDS IV tPA trial demonstrated its safe and effective use if given within 3 hours after the onset of symptoms. Unfortunately only 4% of stroke patients presents within this time window. Those presenting with 6 hours may be eligible for intra-arterial thrombolysis. Cerebral Vascular Insufficiency Cerebral insufficiency may occur in a variety of patient subgroups such as those with moya moya disease, sickle cell disease, cervical or cerebral vessel occlusions. Some patients who suffer from insuffiecient blood flow to the |
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Illustration of carotid
endarterectomy and stenting, courtesy of BNI |
hemispheres may be candidates for a revas- cularization procedure such as a superficial |
Cerebral vascular insufficiency caused by Sickle Cell disease