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Cutting Edge

Title
New technology, techniques treat strokes, aneurysms - Archived
Date
04/08/2013
Article

Dr. Carrington is CAMC's only interventional neuroradiologist.David Carrington, MD, describes himself quite simply as a "brain plumber." But there's nothing simple about what he does. As CAMC's only interventional neuroradiologist, Carrington uses tiny catheters and state-of-the-art imaging techniques to treat complex vascular diseases of the brain and spine without open surgery. Instead, he performs surgery inside tiny, delicate blood vessels.

"Similar to a cardiac catheter that goes to the heart, an endovascular surgical neuroradiologist uses long, specialized tubes (microcatheters) over microwires, and state-of-the-art imaging equipment to treat blood vessel problems in the brain," Carrington said.

Shorter recovery times and decreased procedural risks are among the benefits of endovascular surgical neuroradiology and minimally-invasive neurointerventional techniques. In stroke cases, clot-busting drugs or devices can be delivered directly to the site of a blockage to remove it to prevent the stroke from completing; and in brain aneurysms, specialized coils can be inserted into the aneurysm to prevent it from rupturing and to treat aneurysms that have ruptured.

According to the National Brain Aneurysm Foundation, an estimated 6 million people in the United States (1 in 50) have an unruptured brain aneurysm. Of those, 30,000 will suffer an aneurysm rupture.

There are two approaches to treating an aneurysm: the traditional surgical approach, which involves making an opening in the skull to repair the aneurysm by surgically clipping it; or coil embolization, which is a non-surgical endovascular approach where a tiny catheter is guided from an artery in the groin into the brain vessels and the aneurysm is packed with tiny coils. Coils accomplish from the inside what a surgical clip would accomplish from the outside: they stop blood from flowing into the aneurysm but allow blood to flow freely through the normal arteries.

"An aneurysm is a ballooning of a defect in the blood vessel, much like a tire inner tube balloons out when there is a defect," Carrington said. "As the bulge gets larger the wall of the blood vessel gets very thin and may rupture or give way. Through a tiny catheter, I place coils inside the ruptured aneurysm, which stops bleeding from reoccurring, and also causes the blood to clot, heal and form a scar."

According to the American Stroke Association, most people develop aneurysms after age 40. They tend to develop at branching points of arteries and are caused by constant pressure from blood flow. Aneurysms often enlarge slowly and become weaker as they grow, just as a balloon becomes weaker as it stretches.

"Aneurysms happen in about 6 percent of the population, and generally there are no symptoms," Carrington said. "But if an aneurysm leaks, called a sentinel bleed, it causes tremendous pain. Patients feel an extreme headache, which is like being hit in the head with a baseball bat. That pain often subsides for several days or a week before it fully ruptures."

While it is unknown why an aneurysm bleeds or exactly when it will bleed, Carrington says there are risk factors people can control to reduce their chance of bleeding from a brain aneurysm. Most notably the risk factors are smoking, high blood pressure and heavy alcohol use. These are some of the same risk factors for stroke, which occurs when a clot blocks the blood supply to part of the brain or when a blood vessel in or around the brain bursts.

Treatment for stroke depends on the type of stroke: an ischemic stroke is most common, where an artery is blocked; whereas a hemorrhagic stroke involves bleeding into the brain. To treat an ischemic stroke, blood flow must quickly be restored to the brain via intravenous clot-busting medications or endovascular procedures.

Carrington and the team of neurologists, neurosurgeons, radiologists, emergency medicine physicians, pharmacists and medical rehabilitation specialists at the CAMC Stroke Center at General Hospital provide rapid, comprehensive evaluation and management of stroke to provide patients with the most advanced treatment options.

"The intra-arterial treatment for stroke is to go where the stroke is happening, or to the blocked artery itself, and either dissolve the clot using medicine in the microcatheter or capture the clot using a device that can be placed through the microcatheter."

The key to optimal stroke treatment is quick and accurate action. The longer blood flow is cut off to the brain, the greater the damage.

"Many people still don't recognize when they're having a stroke. At first their symptoms may not be perceived as symptoms of a problem, but when they don't get better or when symptoms progress to a profound weakness or difficulty speaking, then they might think it is a stroke."

Carrington says when it comes to stroke, the most important step to survival and reducing disability is seeking immediate medical care at the onset of stroke symptoms: sudden numbness or weakness of the face, arm or leg (especially on one side of the body); sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; and sudden severe headache with no known cause.

Carrington is certified in neuroradiology by the American Board of Radiology.

Carrington came to West Virginia because of the large number of patients with neurovascular disease.

"Interventional neuroradiology has revolutionized how we treat complex cerebrovascular diseases," Carrington said. "We can perform any neuroendovascular procedure that can be done anywhere in the country, which can give some of our most complicated patients a chance for better outcomes."

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