Summer 2003 Issue

Advancements In Endovascular Neurosurgery
Progress continues to be made in the treatment of cerebrovascular disease using minimally invasive techniques.
By Joe Bernard, MD

Carolina Neurosurgery & Spine Associates is playing a leading role in the advancement of endovascular neurosurgery in this region. Technological advances are being made in this field at a tremendous pace allowing more and more lesions to be treated with neuroendovascular therapy. Although not all vascular pathologies are candidates, certain aneurysms, AVMs, and atherosclerotic plaques are readily treatable from within the blood vessels through a needle-stick incision.

We are proud to be one of only twelve centers participating in a national trial using a new stent along with a distal protection device for carotid artery stenosis. As opposed to some other studies, this is for patients who have a “high-risk” status and are otherwise not candidates for carotid endarterectomy, the current standard of care. We are also one of only 20 centers in the United States selected to participate in the "MERCI Trial" which allows us to treat acute stroke by using a mechanical device to remove blood clots from arteries in the brain. This makes it possible for patients with stroke to be treated for up to eight hours after symptom onset, instead of only three hours with the current standard of care.

Joe Bernard, MD
For symptomatic intracranial stenosis, angioplasty and stenting is emerging as an excellent treatment for a disease that otherwise carries at least a 10% per year risk of stroke. This is a particular area of interest and experience for our practice, and we are active in the development of this technology.

Another exciting area is the treatment of intracranial aneurysms, using coils to occlude the aneurysm from inside the vessel. It works well as the primary treatment for certain locations and geometric configurations, and is an excellent adjunct to certain aneurysms that cannot be completely treated with craniotomy and clipping. The FDA has recently given approval for two new devices in the treatment of aneurysms. Matrix coils are biologically coated to help seal off the aneurysm. The neuroform stent allows previously untreatable aneurysms to be coiled by protecting the normal brain artery and separating it from the aneurysm.

The methods used to treat these pathologies continue to evolve, and the technological advances are making it safer and easier for the patient. As a group, Carolina Neurosurgery & Spine Associates is committed to the comprehensive care of all vascular pathology related to the brain and spinal cord - from aneurysms, AVMs, and atherosclerosis as well as acute stroke treatment.

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