neurointerventional procedure and lower extremities peocedures for interventional radiology

1. PRESENTED TO :Ms. Kiran Aftab
PRESENTED BY: 1.Ameena Ramzan
2.kaif Ul Wara
3. Sumbal Saleem
4. Tahreem Rehmat
TOPIC OF PRESENTATION:
1.Neurointerventional Procedures
2. Lower Extremities Interventional Procedures

2. CONTENTS:
⦿ NEUROINTERVENTIONAL PROCEDURE
⦿ TYPES OF NEUROINTERVENTIONS
⦿ DIAGNOSTIC NEUROINTERVENTIONS
⦿ THERAPEUTIC INTERVENTIONS
⦿ LOWER EXTREMITIES INTERVENTIONS

3. NEUROINTERVENTIONAL RADIOLOGY:
⦿ Neurointerventional is relatively a new field.
⦿ Is used to describe the approach of treatment of
vessel of brain and within spinal cavity.
⦿ Be it is a stroke,aneurysm or tumor,safe,fast and
timely intervention is compulsory.
⦿ Minimally invasive.

4. INDICATIONS:
⦿ Embolization of vascular malformations involving the
brain, the head & neck region, and the spine & spinal
cord:
Arteriovenous malformations (AVM), arteriovenous fistulas
(AVF), dural arteriovenous fistulas (DAVF).
⦿ Intracranial venous disorders, including dural sinus
stenosis and pseudo-tumor cerebri
⦿ Embolization of tumors
⦿ Intra-arterial chemotherapy for the treatment of tumors.
⦿ Intracranial and extracranial angioplasty,
stenting.
⦿ Stroke and stroke syndromes (i.e. arterial dissections,
Moyamoya syndrome).

5. SPINE INTERVENTIONS
INCLUDING:
⦿ Vertebroplasty
⦿ Treatment of Tarlov’s cysts
⦿ Pain interventions
⦿ Spine biopsy
⦿ Radiofrequency tumor ablation
⦿ Myelography

6.  Discography
 Lumbar puncture

7. TYPES OF NEUROINTERVENTION:
Neurointerventional
procedures
Diagnostic Therapeutic

8. DIAGNOSTIC:
1. Cerebral
angiography
2. Spinal
angiography

9. CEREBRALANGIOGRAPHY:
⦿ Cerebral Angiogram:
• Cerebral angiography :
 Images of blood vessels in and around the brain.
 Detection of abnormalities such as AV malformation and
aneurysm.
 Neuro-angiographers
 Using modern sophisticated imaging equipment.
 A contrast medium, or “dye,” is injected into the targeted
vessel through a small, soft, and flexible tube called a
catheter.

12. Vertebroplasty and Kyphoplasty
Vertebroplasty and Kyphoplasty are treatments for
pain caused by compression fractures in the spine - a
common problem in patients with osteoporosis or
spinal tumors.

13. How does the procedure work?
 Your interventional neuroradiologist will insert a needle through
the skin and into the fractured vertebra.
 The needle is precisely guided using fluoroscopy - real-time,
moving X-ray images that your radiologist can view on a TV
screen.
 Your doctor will then inject orthopedic cement into the vertebra
and possibly use a balloon device to expand the space in the
vertebra (kyphoplasty).

15. Myelography
 Myelography is a diagnostic imaging procedure to assess
conditions affecting the spinal cord and spinal nerves.
 The procedure involves a special contrast material, or dye, injected
into the spinal column and real-time, moving X-ray images
(fluoroscopy).
 Your interventional neuroradiologist may use myelography to
diagnose disc abnormalities, such as herniated discs, identify
tumors or pinpoint nerve conditions.

16. How does the procedure work?
 Under X-ray guidance, your interventional neuroradiologist will
inject dye into the spinal canal.
 The dye allows your radiologist to more clearly see the spinal cord,
nerves and other nearby structures.
 X-rays images are then taken of the area of the spine being
studied to document any abnormalities.
 Myelography may be done in combination with other imaging
procedures, such as a CT scan, to get a clear picture of the spinal
anatomy.

18. Discography
 Discography is a diagnostic imaging procedure to evaluate
intervertebral discs - the spongy cartilage that provides
cushioning between the bones (vertebrae) in the spine.
 The procedure can help determine the cause of back pain and
provide your doctor with the information he or she needs to treat
it.

19. How does the procedure work?
 Using X-ray guidance, your interventional neuroradiologist will inject
a contrast liquid (dye) into one or more discs being evaluated.
 The contrast material provides sharper images during fluoroscopy.
 Fluoroscopy uses X-rays to create real-time, moving images of a
disc that your radiologist can view on a TV screen.
 Discography is performed under mild sedation so the patient can
explain any pain or other symptoms during the test

21. Lumbar Puncture
 A lumbar puncture, also known as a spinal tap, is a minimally
invasive procedure to diagnose diseases of the nervous system.
 A thin needle is inserted in the lower part of the spinal column to
collect a small amount of spinal fluid.
 The fluid is then tested to detect bleeding, to diagnose infections
such as meningitis

22. How does the procedure work?
 Your interventional neuroradiologist will have you lie still on your
side or abdomen.
 After injecting a local numbing medication, he or she will insert a
needle into the spinal column using precise, X-ray imaging
guidance.
 The needle is used to collect cerebrospinal fluid, which cushions
the brain and spine from injury.
 The fluid is then sent for testing following the procedure, which
lasts 20 to 30 minutes.

24. SPINAL ANGIOGRAM:
⦿ A diagnostic spinal angiogram is a medical procedure
that offers an extremely precise evaluation of the
blood vessels surrounding the spinal cord.
⦿ During a spinal angiogram, highly specialized
doctors (called neuro-angiographers) are able to
observe arteries and veins by using modern
imaging equipment.
⦿ This catheter is inserted in the groin and
carefully advanced into the targeted blood vessel
under the guidance of low dose x-rays.

25. PATHWAY OF SPINE:

26. PROCEDURE:

27. THERAPEUTIC PROCEDURE:
⦿ E n d o v a sc u la r
t r e a t m e n t o f
a neury sms
⦿ Serious medical conditions
who are unable to sustain the
stress of surgery.
⦿ Platinum coils are guided into
the aneurysm via a catheter,
creating a clot that effectively
closes the aneurysm off from
the surrounding circulation,

28. E n d o v a s c u l a r t r e a t m e n t o f A V M
 One innovative form of treatment involves use of
a"super glue" substance introduced via a tiny
catheter to reduce the size of the AVM and facilitate
further microsurgical or radiation treatment.
 In some cases, it is possible to completely block off
and cure the AVM with endovascular treatment alone.

29. Angioplasty and stenting of v e s s e l s in t h e
neck and brain
⦿ Angioplasty and stenting of vessels in the neck and
brain are other new endovascular procedures
available at only a few institutions nationwide.
⦿ Cerebral angioplasty is similar to a widely used
cardiology procedure and is used to open partially
blocked vertebral and carotid arteries in the neck,
as well as blood vessels within the brain.

30. LOWER EXTREMITIES

31. INDICATIONS:
 Ischemia
 Blockage in arteries
 Bypass graft
 Stenting
 Angioplasty
 Atherosclerosis

32. ❖ Bypass graft
❖ Percutaneous angioplasty
❖ stents
INTERVENTIONAL PROCEDURE
LOWER EXTREMITIES

33. PERIPHERAL ARTERY BYPASS
● Peripheral artery bypass is surgery to reroute the blood
supply around a blocked artery in one of your legs
● Fatty deposite can build up inside the arteries and block
them
● Agraft is used to replace or bypass the blocked part of the
artery
● The graft may be a plastic tube or it may be a bloodvessel
taken from your body

34. DESCRIPTION
Peripheral artery bypass can be done one or
more of the following blood vessels
❖ Aorta
❖ Artery in your hip
❖ Artery in your thigh
❖ Artery behind your knee
❖ Artery in your lower leg

35. PROCEDURE
● You will receive medicine (anesthesia) so that you do not feel pain
● Your surgeon will make a cut over the part of the artery thatis
blocked
● After moving skin and tissue out of the way the surgeon will place
clamps at each end of the blocked section of artery the graft isthen
sewn in place
● The surgeon will make sure you have good blood flow in your
extremity then your cut will be close you may have an X-Ray called an
Arteriogram to make sure that the graft isworking

37. ● Leg bypass surgery carries significant risks including
● Heart attack
● Blood clots
● Infections
● Even death 2 to 3 % of the patients
● Cardiac problems
❖ Careful review of medical therapies required prior to
surgery
RISKS

38. ● The use of medication such as aspirin, blood pressure and
cholestrol lowering drugs is critical before and after the
operation
● Overall bypass surgery is immediately successful in 90 to
95% of cases
● The best result are obtained by using a patient’s own vein

39. PERCUTANEOUS TRANSLUMINAL
ANGIOPLASTY

40. WHAT IS PTA
● Percutaneous transluminal angioplasty is a
procedure that can open up a blocked blood vessel
using a small flexible, plastic tube or catheter with
a Baloon at the end of it
● When the tube is is in place it inflates to open the
blood vessel or artery so that normal blood flow is
restored

42. WHY IS IT NECESSARY
● Fatty deposits can bulid up in your blood vessels reducing blood
flow and in some cases, blocking it completely
HOW IS IT DONE
● The radiologist will insert a baloon-type catheter into an artery
in your groin or arm the doctor will inflate the baloon several
times for about one minute each time in order to push the fatty
deposits against the artery wall
● The technologists working with the doctor will take X-Ray
picture to make sure the blockage is opened
● When blood flowing freely through the artery the baloonis
deflate and taken out

43. STENTS

44. ❖ Astent is a small metal mesh tube that keeps
the artery open
❖ Astent placement is a way to open blocked
peripheral arteries

45. ● The procedure to place the stent to treat coronary
and carotid arteries are similar
● In procedure a thin tube with a deflated baloon on the
end is threated through a blood vessel to the
narrowed or blocked artery
● Once in place the baloon is inflated and the stent is
opened and place in the artery
STENTING PROCEDURE

47. THANKYOU