Interventional neuroradiology is based on performing minimally invasive treatments in the brain or spinal cord through catheterization. This medical specialty focuses mainly on two groups of pathologies. On the one hand, vascular malformations, such as aneurysms and arterio-venous malformations; and on the other hand, cerebral embolisms or thromboses.
How do vascular malformations affect people?
Within this type of malformation, the most common is cerebral aneurysm. This is a birth defect in the artery wall, more specifically, it consists of the absence of one of the three layers that the arterial wall should have. Thus, the impact of the blood against this area of weakness causes the formation of a blood pocket called aneurysm.
The main problem is that this pathology is not usually discovered until the pocket ruptures (hemorrhage or stroke) and, at that moment, the consequences are already very serious. Half of the patients who have a bleeding caused by an aneurysm die before arriving at the hospital, while of the other half, only 50% can recover their normal life.
Vascular malformations: how can an aneurysm be prevented and how is it treated?
The key is to detect the aneurysm before it bleeds. To do this, an MRI with angioresonance must be performed, and 95% of aneurysms are detected in this way.
If the aneurysm is discovered, its occlusion and cure is performed with endovascular techniques, less invasive and with fewer risks than traditional neurosurgical techniques, since they offer a better quality of life.
Thus, to treat it, a puncture is made in the leg to perform a catheterization in the femoral artery, thus being able to navigate through the arteries to reach the aneurysm. Once in the blood bag, it is filled with platinum coils in order to seal it and prevent blood from entering. If the neck of the aneurysm is very wide, the coils are placed inside, but stents (endovascular prostheses) are also placed to ensure the stability of the coils and to induce the formation of a new wall in front of the aneurysm.
Arteriovenous malformations
This consists of a defect in the formation of the vessels of the brain or spinal cord that alters the communication between arteries and veins. This causes failures in cerebral oxygenation, which can lead to epilepsy or even alter brain functions. In the case of the spinal cord, it can cause loss of strength or sensitivity in both arms and legs. However, the main point to note is that these malformed vessels may rupture spontaneously, causing bleeding in the brain or spinal cord.
When it is proven that it is really a malformation, the intervention is very similar to that of vascular malformations. The arteries are navigated until the malformation is reached, and once there, the abnormal communications between arteries and veins are plugged with liquid substances which, when they come into contact with the blood, become solid.
Interventional neuroradiology in Spain
Within the field of interventional neuroradiology, in Spain we have the Endovascular and Percutaneous Therapeutics Service of the Hospital Nuestra Señora del Rosario in Madrid, formed by Dr. Leopoldo Guimaraens and Dr. Jacques Theron, as well as myself.
The origin of this team goes back to the 80’s, when I met Dr. Theron while Dr. Guimaraens and Dr. Guimaraens were working together. Guimaraens worked in Paris, where we met. Guimaraens returned to Spain, establishing himself as Head of Diagnostic and Therapeutic Neuroangiography at the General Hospital of Catalonia, where, thanks to the collaboration of Dr. Theron, the first Carotid Angioplasty with Cerebral Protection and placement of endovascular prostheses was developed for the first time in Spain. For my part, I was still working in Paris, where I had specialized in the treatment of vascular, cerebral and spinal malformations, so we decided to join and create a new team of interventional neuroradiology, co-directing since 2000 the Service of Endovascular and Percutaneous Therapeutics of the Hospital Nuestra Señora del Rosario in Madrid.