Complete Spectrum of Neurovascular Disease
The CPNI Cerebrovascular Division handles all vascular disorders affecting the nervous system, including cerebral aneurysm, subarachnoid hemorrhage, ischemic stroke, arteriovenous malformations, and cerebral and extracranial arterial occlusive disease. The division is unique in its disease-oriented (as opposed to technique-oriented) approach to vascular disorders: Both endovascular and microsurgical techniques are routinely used in the treatment of neurovascular lesions. All cerebrovascular procedures are performed with real-time intraoperative neurophysiologic monitoring by a dedicated team in the operating room. The new cerebrovascular operating room at CPNI is dedicated to the treatment of complex vascular disorders, including acute ischemic stroke. It is a state-of-the-art combined operating room and interventional neuroradiology suite, complete with the most modern digital imaging and biplane angiographic equipment available, capable of handling all conceivable vascular procedures without having to move the patient.
The full complement of neurovascular interventions at CPNI: combination treatments advantage
This disease orientation provides powerful advantages for CPNI in the treatment of these highly complex and dangerous disorders. Every microsurgical intervention today has an endovascular counterpart: Cerebral aneurysms may be coiled or clipped; arteriovenous fistula may be embolized or resected; carotid arteries can be angioplastied and stented or endarterectomized. Endovascular methods may be combined, or added to microsurgical ones, to provide creative, effective, and versatile treatment for appropriate lesions, e.g., a wide-necked aneurysm in a difficult location may have an intracranial stent deployed across its base to protect the parent vessel lumen (image: wide-necked aneurysm) or have its neck reconstructed by a partial clipping before definitive coil embolization. Arterial tortuosity in the periphery may be bypassed surgically to make an intracranial aneurysm embolization possible; a peripheral blood vessel of the eye may be opened surgically and used to transmit a catheter intracranially to treat a fistula of the cavernous sinus.
Multiple simultaneous disorders: cerebral aneurysm, subarachnoid hemorrhage SAH, ischemic stroke, and carotid dissection
Vascular diseases of the nervous system also are not uncommonly characterized by multiple simultaneous disorders. Cerebral aneurysms are multiple in 20% of cases, and subarachnoid hemorrhage (SAH) may be non-localizing. In this situation, open operation carries a very real risk of being carried out on the incorrect side. It may be advantageous to perform coil embolization of multiple aneurysms in a single procedure.
Ischemic stroke may be effectively treated by intraarterial thrombolysis, or by mechanical clot disruption within the affected artery, as an adjunct to or substitute for intravenous tPA. A concomitant (causative) stenosis or dissection of a parent artery may be simultaneously treated by angioplasty or stenting.
Concomitant cardiovascular disease
Many cerebrovascular diseases are accompanied by cardiac or hematological conditions that are ameliorated by systemic antiplatelet or anticoagulation therapy. Severe SAH often presents with myocardial ischemia, and both ischemic and hemorrhagic stroke often occur in patients with other cardiovascular diseases. Endovascular procedures are routinely carried out under full anticoagulation, providing a convenient, safer platform for simultaneous treatments.
Reduced time under anesthesia
Endovascular procedures are generally accomplished in a relatively brief time frame. Whereas microsurgery for ruptured aneurysm may require 6-8 hours, coil embolization may be accomplished, in many cases, in less than one hour. Patients with additional medical conditions or patients of advanced age or frail health may benefit considerably from having these operations included in the neurosurgical armamentarium.