Stroke and Aneurysm Treatment
A 26-year old woman was transferred to Millard Fillmore Gates Circle Hospital with a 4-hour history of right-sided paralysis and fluctuating speech problems. Recognizing a possible stroke, ER staff immediately contacted UBNS physicians who ordered a cerebral angiography which revealed a blockage in the middle cerebral artery.
Reteplase--a thrombolytic medication used to break up or dissolve blood clots-was administered with no effect. UBNS physicians then acted quickly to deploy two 3x12-mm balloon-mounted stents-small, cylindrical devices used to support the integrity of vessel walls--resulting in the complete recanalization of the artery.
The patient was discharged from the hospital four days later with complete motor recovery and only subtle speech disruption. She was re-evaluated at our office one week later and did not demonstrate any neurological deficits.
UBNS specializes in the treatment of neurovascular disease-an umbrella term that refers to complex disorders of the brain, spinal cord, and blood vessels. Common types of neurovascular disease include stroke and aneurysms.
Acute stroke occurs when a major artery carrying blood to the brain is suddenly blocked by a clot. As with a heart attack, reopening the vessel in a timely fashion in order to restore blood flow to the affected tissue is imperative to successful treatment and recovery.
UBNS is the integral, neuroendovascular component of the renowned Kaleida Health Stroke Care Team at the Gates Vascular Institute. The Stroke Care Team is a highly skilled multidisciplinary blend of neurosurgical, neurological, and emergency medical professionals trained in specialized comprehensive acute stroke care.
The team operates out of the Gates Vascular Institute, which was named a Designated Stoke Center by the New York State Department of Health, and is also the only hospital in Western New York to have achieved disease-specific care certification for acute stroke from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Less than 1% of US hospitals have received this certification.
UBNS, as part of the Stroke Care Team, is committed to delivering rapid stroke treatment. Our world-renowned endovascular team, led by Drs. Hopkins, Levy, Siddiqui, and Snyder, is on-call 24-hours a day to treat any stroke patient admitted to the Gates Stroke Center-a facility equipped to provide a full gamut of comprehensive stroke treatment options using state-of-the-art minimally invasive techniques, many of which were pioneered right here in Buffalo. Our endovascular team routinely performs accurate clinical evaluation, appropriate diagnostic studies, and inter-arterial catheterization within one hour of a stroke patient's arrival in the emergency room. This is critical, as stroke treatments are most effective in reducing damage when administered within three hours of symptom onset.
Intracranial aneurysms -- a localized dilatation or "ballooning" of a blood vessel that forms in the brain resulting in a weakness in the vessel wall--are common. Approximately 5% of the general population harbors an intracranial aneurysm at any given time.
Ruptured intracranial aneurysms are one of the leading causes of hemorrhagic stroke, and the most devastating causes of hemorrhagic stroke in younger patients. Evidence suggests that intracranial aneurysm patients who are transferred to large case-volume centers, where specialized multidisciplinary teams and neurointensive care management are readily available (such as Millard Fillmore Gates Circle Hospital), fare much better than those who are treated at smaller, less specialized institutions. In general, aneurysm patients also do best at institutions where a single specialty, such as neurosurgery, directs every stage of patient care.
At the Gates Vascular Institute, our neurosurgical and neuroendovascular team are one and the same, our emergency personnel are equipped to quickly obtain imaging studies, ventriculostomies are immediately available and rapidly inserted, and the expert nursing staff is finely tuned to changes in a patient's neurological status. Add in the benefits of our neurosurgical intensive care unit, and our highly skilled neurosurgical and neuroendovascular fellowship and residency teams, and you have the best possible environment for successful treatment of intracranial aneurysms.
Currently, there are two main treatments for cerebral aneurysms: open surgical craniotomy clip reconstruction or endovascular coil embolization. The techniques for open surgical clip reconstruction of aneurysms have remained largely unchanged over the last decade, whereas dramatic developments have occurred in endovascular coil embolization techniques. Coil embolization has evolved from an experimental technique reserved for patients too ill for surgery to an extremely viable technique that now accounts for 50% of aneurysm treatments in the United States.
The highly regarded endovascular team at UBNS specializes in the performance of endovascular coil embolization. Studies show that the propensity of a hospital to use endovascular methods is associated with better outcomes.
OTHER NEUROVASCULAR DISEASES
Other diseases of the neurovascular system include, but are not limited to, arteriovenous fistulas, arteriovenous malformations, carotid and peripheral artery disease, intracranial stenosis, and vascular tumors.
The skilled physicians of UBNS have extensive experience treating each of these conditions. To learn more about neurovascular diseases, and possible treatment options, please visit the Brain and Spine Disorders index, or call our office at (716) 218-1000 to speak with a member of our medical staff.
UBNS is continually immersed in ground-breaking research to advance the science behind the prevention and treatment of neurovascular disease. Our Toshiba Stroke & Vascular Research Center is an internationally recognized hub of translational research, meaning that our physicians readily transfer innovations in neurovascular treatment from our lab to the clinical setting for immediately observable results. We apply research to patient care at an impressive rate, and can thus offer our patients the latest neurovascular therapies, in addition to more conventional treatment options.
Click here to learn more about the translational research program at UBNS.