Neuroradiology is the subspecialty that deals with the diagnosis and treatment of brain, spinal cord, head and neck, and vascular lesions using x-rays, magnetic fields, radio waves, and ultrasound.
Neurointerventional Radiology involves angiography and embolization procedures, which are performed in a specially designed suite at Doctors Hospital, 5000 University Drive, in Coral Gables. For more information, call 786-308-2300.
This special suite has anesthesia and monitoring equipment, as well as sophisticated X-ray equipment, to ensure that the patient is comfortable and safe.
Angiogram and Embolization
What is an angiogram?
An angiogram is a series of pictures of the blood vessels which supply blood to a particular part of the body. Cerebral angiography is a diagnostic procedure used to evaluate the brain for arterial and venous occlusive diseases, aneurysms and arteriovenous malformations (AVM). An angiogram can be useful in determining the blood supply of certain tumors. It is the primary diagnostic tool used by a neuroradiologist to visualize the blood vessels of the neck, face and brain.
What does an angiogram procedure entail?
A flexible catheter, which looks like a thin tube, is used. This is usually introduced through the patient's femoral artery in the upper leg. Prior to making a small incision, a local anesthetic is administered. Often, intravenous medication (sedation) is also used. Using X-ray guidance, the catheter is then directed through the artery into the area to be studied.
The principle of angiography is to inject contrast material dye into a blood vessel while taking rapid X-ray exposures. This results in high-detail images of the blood vessels in the head. The patient must remain very still while X-ray images are being made. Just as movement while taking a picture results in a blurred image, movement during an angiogram produces blurred X-ray images. Although the procedure may feel mildly uncomfortable, it is not painful. A typical angiography procedure can last 20 to 60 minutes. The neuroradiologist is present throughout the procedure and is available before the procedure to answer any questions the patient may have.
What is an embolization?
Embolization is not a diagnostic procedure, but a sophisticated treatment option used for a variety of neurological diseases involving blood vessels and tumors. Embolization can close abnormal vessels and aneurysms in the brain, face and neck. It is most often used in combination with other methods of treatment, such as radiosurgery or neurosurgery, although it can be curative for certain problems. In some cases, embolization is beginning to replace surgery in the treatment of various complex cerebrovascular disorders.
What does an embolization procedure involve?
Even though there is no scar, embolization is neurosurgery. Patients undergoing embolization need pre-operative testing, which may include blood work, a physician evaluation, consent and usually a CT scan or MRI. These tests are performed prior to the embolization procedure.
General anesthesia is typically used in the treatment of aneurysms. Prior to starting the embolization procedure, a small catheter is placed in the patient's bladder so that urine may flow freely. The patient's groin area will be shaved and cleaned in preparation for the procedure. To avoid movement, the patient's arms and legs will be positioned with special holders. Embolization is performed by placing a small tube (catheter) through the femoral artery in the leg under X-ray guidance. Smaller catheters are passed through the inside of this catheter into the brain and the abnormal vessels.
Before the actual treatment begins, several angiograms are performed to provide important information on the area of the brain where the vessel is located. If awake, the patient is asked to remain very still while X-ray images are made. In the case of AVM embolization, medication is injected to determine if the artery may be safely blocked. The entire embolization procedure can last three to six hours and may be slightly uncomfortable, but not painful. The neuroradiologist present throughout the embolization procedure and is available prior to the procedure to answer any questions the patient may have.
What happens after an embolization?
After the procedure, the small catheter is removed. The patient is cared for overnight in the Critical Care Unit (CCU), located on the second floor of Doctors Hospital. While in the CCU, the patient is carefully monitored. The next day, catheters and monitoring devices are typically removed and the patient is transferred to a private room on a regular hospital floor. Discharge is usually on the third hospital day. Visiting hours for regular hospital floors are 11 a.m. – 8 p.m. Visiting hours for the CCU are 10 - 10:30 a.m., 1 - 1:30 p.m., 5 -5:30 p.m., and 9 - 9:30 p.m.
What to expect after going home?
After being discharged from the hospital, the patient can resume daily living activities. A normal diet, travel and light exercise is permissible. The patient may feel a little tired for a few days. Typically patients are placed on a few medications for the week following discharge, and a complete instruction sheet is given to the patient prior to discharge. Follow-up is very important. A follow-up visit with the referring physician is scheduled. Future procedures, if required, changes in medications and other important instructions are discussed in detail with the patient at the time of discharge. Patients will receive written discharge instructions in either English or Spanish.