Stroke & Brain Aneurysm Center of Long Island - Treatments

Cerebral Angiogram

A cerebral angiogram is a minimally invasive procedure that is done to evaluate the blood vessels of the neck and brain for aneurysms, arteriovenous malformation, or stenosis. A catheter is inserted through the groin (femoral artery) and navigated to the patients head under x-ray. The pictures obtained provide detailed information of the blood vessels. The procedure from start to finish is approximately 20 minutes. General anesthesia is not necessary for this procedure. Most patients can go home a few hours after the procedure. 

Spinal Angiogram

A spinal angiogram is a minimally invasive procedure that is done to evaluate the blood vessels of the spine for arteriovenous malformations or aneurysms. A catheter is inserted through the groin (femoral artery) and navigated to the patients aorta under x-ray. The pictures obtained provide detailed information of the spine blood vessels. The procedure from start to finish is approximately 30 minutes. This procedure is performed under general anesthesia. Most patients can go home a few hours after the procedure. 

Cerebral Angiogram Coiling

Cerebral aneurysm coiling is a minimally invasive treatment for ruptured or unruptured cerebral aneurysms. This procedure is performed under general anesthesia. Catheters are inserted through the groin and navigated to the patients head and eventually inside the aneurysm, where platinum coils are deployed in order to occlude the aneurysm. In some circumstances, a stent is necessary to assist the coils by providing a “shelf” to keep the coils in position. After the procedure, patients are admitted to the Neuro ICU for observation and generally are able to go home the following day. 

Cerebral Aneurysm Flow Diversion

Cerebral aneurysm flow diversion is another minimally invasive treatment option for some patients with cerebral aneurysms (based on aneurysm location, size, and complexity). This procedure is performed under general anesthesia. Catheters are inserted through the groin and navigated to the patients head and eventually a flow diverting stent is deployed to bridge the neck of the aneurysm. The purpose of the stent is to divert the flow away from the aneurysm and has the consistency of a screen door.  Once the stent is in place, blood flow is immediately diverted and in most cases the aneurysm clots off and healed within six months. After the procedure, patients are admitted to the Neuro ICU and generally are able to go home the following day. After the stent is in place, patients are maintained on blood thinners for at least six months.

Cerebral Aneurysm Clipping

Cerebral aneurysm clipping is a procedure that is done when a brain aneurysm is not amendable to treatment via the endovascular approach (through the groin). This procedure is performed under general anesthesia in the operating room.  An incision is made on the skull and a window of bone is removed to access the brain aneurysm. Once the aneurysm is identified, a surgical clip is placed at the neck (base) of the aneurysm to pinch it off. The clip is permanent and will not be removed. During the procedure an intraoperative angiogram will be completed to evaluate blood flow through the normal blood vessels. After the clipping is completed, the window of bone is replaced and secured with screws. After the procedure, patients are admitted to the Neuro ICU for observation and generally are able to go home in 2-5 days. 

Onyx Embolization

Onyx embolization is a minimally invasive treatment available for patients who have a cerebral AVM or other vascular malformation. This procedure can also be done prior to removal of a brain tumor to minimize the amount of bleeding during surgery. This procedure is performed under general anesthesia. Catheters are inserted through the groin and navigated to the patients head and eventually in the malformation or tumor, where Onyx is deployed. Onyx, which is a glue-like substance, is injected to occlude the abnormal connections in the vascular malformation. In some patients, this procedure is necessary multiple times depending on the size of vascular malformation. After the procedure, patients are admitted to the neuro ICU and generally are able to go home the following day. 

Stereotactic Radiosurgery

Stereostactic radiosurgery (SRS) is a minimally invasive procedure that can be used to treat certain AVMs or other vascular malformations. SRS is a form of radiation targeted to “shrink” the vascular malformation and spare healthy brain tissue. This procedure is an alternative to surgical removal of the malformation. A stereotactic frame is placed on the patient's head the morning of the procedure and subsequently the treatment is delivered in one sitting. Most patients can go home a few hours after the procedure. 

Mechanical Thrombectomy

Mechanical thrombectomy is a minimal invasive procedure that is done emergently for ischemic stroke patients. Only patients with the most severe strokes, secondary to blockage of a large blood vessel, are candidates for this procedure. This procedure is performed under general anesthesia. Catheters are inserted through the groin and navigated to the patients head and eventually through the blocked area. A retrievable stent that acts as a fishnet is deployed within the clot. After five minutes, suction is applied and the stent is removed, carrying the clot out of the body and allowing blood to flow again through the blood vessel. After the procedure, patients are admitted to the neuro ICU for continued care. Generally, patients are in the hospital for 3-5 days for further workup on the cause of their stroke. Depending on whether the symptoms of stroke are completely resolved, some patients might need rehabilitation services.

Carotid Artery Stenting

Carotid artery stenting is a minimally invasive procedure performed to prevent ischemic stroke in patients with carotid stenosis, secondary to build up of atherosclerotic plaque. Patients are eligible for this procedure depending on the anatomy of their disease. This procedure is performed under general anesthesia. Catheters are inserted through the groin and navigated to the patients neck and eventually through the area of atherosclerosis. A protection device is deployed above the stenosis to catch any debris prior to stent placement. Once the protection device is in place, a balloon is inflated within the carotid artery. Subsequently, the stent is placed to keep the vessel open. After the procedure, patients are admitted to the neuro ICU and generally are able to go home the following day. ​After the stent is in place, patients are maintained on blood thinners for a few months.

Carotid Endarterectomy

Carotid endarterectomy is a procedure performed to prevent ischemic stroke in patients with carotid stenosis, secondary to build up of atherosclerotic plaque. Patients are eligible for this procedure depending on the anatomy of their disease. This procedure is performed under general anesthesia in the operating room. An incision is made on the side of the neck, the carotid artery is opened and cleaned by removing the plaque. The incision is closed from the inside so there are no sutures seen on the skin. After the procedure, patients are admitted to the neuro ICU and generally are able to go home the following day.

Epistaxis Particle Embolization

Epistaxis particle embolization is an emergency minimally invasive treatment available for patients who have persistent, life-threatening nose bleeds that do not respond to packing or other methods of control. This procedure is performed under general anesthesia. Catheters are inserted through the groin and navigated to the patients head and eventually in the bleeding blood vessels in the nose. Subsequently, small particles are injected to temporally clot off the vessels and stop the bleeding. After the procedure, patients are admitted to the neuro ICU and generally are able to go home within 1-2 days.   

Extra-Cranial Intra-Cranial Bypass

Extra-Cranial Intra-Cranial (EC-IC) bypass is a procedure that is done for patients diagnosed with MoyaMoya disease to restore blood flow to the brain. This procedure is performed under general anesthesia in the operating room. An incision is made on the skull and the superficial temporal artery (normally supplying the scalp) is identified. Subsequently, a small window of bone is removed and the scalp artery is placed on the brain to bypass the blockage. The bone is placed back and secured with screws. After the procedure, patients are admitted to the neuro ICU and generally are able to go home within 2-3 days.   

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