Interventional Radiology, Surat

WHAT IS ISCHEMIC STROKE?

Strokes can also be caused by a blockage in blood flow. This blockage causes a lack of blood flow to portions of the brain. The brain injury is called ischemia (literally, lack of blood).

During a stroke, one or more areas of the brain can be damaged. Depending upon the area affected, a person may lose the ability to move one side of the body, the ability to speak, the ability to see normally, or a number of other functions. The damage may be temporary or permanent, and the function may be partially or completely lost. A person's long term outcome depends upon MOW MUCH brain is damaged, HOW QUICKLY treatment begins, and a number of other factors.

EARLY TREATMENT and PREVENTIVE measures can reduce the brain damage that occurs as a result of a stroke.

The treatment of a stroke depends upon the type of stroke (eg, ischemic or hemorrhagic), the time since the first stroke symptoms occurred, and the patient's underlying medical problems.

VERY EARLY TREATMENTS — The goal of treatment is to restore blood flow to the affected area of the brain as quickly as possible, which means WITHIN THE FIRST FEW HOURS after the stroke begins. The main very early treatments for ischemic stroke are:
●Intravenous thrombolytic ("clot buster") therapy with alteplase
●Intra-arterial mechanical thrombectomy (opening of the blocked artery) with stent retriever devices
Both thrombolytic therapy and mechanical thrombectomy require care in a hospital that can coordinate emergency services, rapid consultation with a neurologist (a physician who specializes in the brain), interventional radiologist (a physician who specializes in minimally invasive treatment), intensive care services, and brain and vascular imaging with CT or MRI scans.

IV THROMBOLYTIC THERAPY — Intravenous thrombolytic therapy uses a medication called tissue plasminogen activator (tPA, alteplase) that is injected into a vein. Alteplase works to dissolve clots that are blocking blood flow within arteries of the brain.

The benefit of thrombolytic treatment SLOWLY DECREASES over several hours. Thus, the earlier the treatment is given after the stroke begins, the more likely the artery can be opened.

MECHANICAL THROMBECTOMY — Intra-arterial mechanical thrombectomy is a treatment that uses a catheter containing a device called a stent retriever. The catheter is placed within an artery to the brain and guided to the clot that is causing the stroke symptoms. This stent retriever device can restore blood flow to the brain by capturing and removing the clot blocking the large artery.

Mechanical thrombectomy can be beneficial if it is given WITHIN SIX HOURS from the start of the stroke symptoms. It is used only for patients who have a blockage in one of the LARGE ARTERIES within the brain, so not all patients with ischemic stroke will need this type of treatment.

For those who do need it, the sooner mechanical thrombectomy is started, the more likely that it will help. In randomized controlled trials, patients treated with mechanical thrombectomy had a significantly higher rate of functional independence compared with patients who received the usual treatment, which was generally intravenous thrombolytic therapy.

OTHER EARLY TREATMENTS — The medicines used for the early treatment of ischemic stroke are aspirin and anticoagulants.

Visit tiny.cc/irstroke for more information!

Source: http://www.uptodate.com/contents/ischemic-stroke-treatment-beyond-the-basics

Endovascular treatment of stroke are now the treatment of choice in large vessel occlusive ischemic stroke

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Flow Diversion for Aneurysms with Stents

What is flow diversion?

Flow diversion is an endovascular technique whereby instead of placing a device inside the aneurysm sac, such as coils, the device is placed in the parent blood vessel to divert blood flow away from the aneurysm itself.

How is flow diversion performed?

During a flow-diversion procedure, a microcatheter is navigated past the aneurysm without having to enter the aneurysm. Then, the flow-diverting device is deployed across the neck of the aneurysm in the parent blood vessel where the aneurysm is present.

Almost immediately the blood flow to the aneurysm is reduced, and the complete closure of the aneurysm occurs between 6 weeks to 6 months after the procedure.

Reasons for having flow diversion performed

A flow diversion procedure may be performed to treat an unruptured brain aneurysm. Flow diversion is one method of removing the need to enter the aneurysm, which is the most dangerous part of endovascular treatment of aneurysms. The risk of rupturing the aneurysm during surgery is greatly diminished by not placing a device inside the aneurysm.

Visit tiny.cc/irad and tiny.cc/coiling for more information!

(Source: http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/aneurysm/treatment/flow-diversion.html)

UTERINE ARTERY EMBOLIZATION (UAE)
An interventional radiological technique to occlude the arterial supply to the uterus and is performed for various reasons.

History
Practised for more than 20 years for controlling haemorrhage following delivery / abortion, in ectopic or cervical pregnancy, gestational trophoblastic disease or carcinoma cervix
The technique was first reported as an effective intervention for fibroids in 1995 when Ravina et al noted that several women with symptomatic leiomyomata who underwent UAE as a pre-hysterectomy treatment had significant clinical improvement to an extent that hysterectomy was no longer required.
It is now estimated that more than 100,000 UAE procedures may have been performed so far for the treatment of fibroids.

INDICATIONS:
1) post partum hemorrhage
2) intramural fibroids
3) dysfunctional uterine bleeding
4) adenomyosis
5) uterine artery pseudoaneurysm(s)
6) uterine AVM

UTERINE FIBROIDS:
People with uterine fibroids traditionally undergo total abdominal, vaginal or laparoscopic assisted hysterectomies around the world. In less developed and more populous countries like India, the numbers may be even higher. There is an increasing need for non-invasive or less invasive alternatives for uterine fibroids and dysfunctional bleeding.

Pre-procedural evaluation
a thorough evaluation of patients symptoms and signs in consultation with a gynaecologist
pelvic ultrasound and MRI
pap smear and endometrial biopsy
relevant history of other medical problems
allergies

EMBOLIC AGENTS
The type of embolic agent selected will depend on the indication.
A] Fibroids
- PVA (300-350 microns)
- embospheres
B] Post-partum haemorrhage or vaginal bleeding
- gel foam particles
- coils (occasionally)
- n-butyl-cyanoacrylate (glue)

OUTCOMES
For vaginal bleeding
- alleviates need for emergency hysterectomy
- resumption of menstruation
- successful pregnancy after UAE for PPH
- unsuspected abnormalities treated during UAE for PPH
For fibroids
- menorrhagia / dysmenorrhoea and metrorrhagia improve in 70-95% of cases
- hospital stay is rarely >48 hours
- patients are often back to work within 10 days
- no post laparotomy complications
- mean uterine volume reduction by 26-59%
- fibroid volume reduction by 40-75% (at the end of 6 months)
- overall complication rate is ~10% with major complications at ~1.5%

CURRENT RECOMMENDATIONS:
ACOG in 2008 issued guidelines that patient with fibroids can be given an option of UAE
NICE(UK): in 2007 recommended UAE with surgery as a first line treatment option

Visit tiny.cc/embolize for more information!

(Source: https://radiopaedia.org/articles/uterine-artery-embolisation)
(Pic: http://blogs.nejm.org/…/inde…/uterine-fibroids-2/2015/04/24/)