Photos of Interventional Neuroradiology Procedures

Case Examples: Angioplasty and stenting, Aneurysm treatment
with GDC coils, Intracranial angioplasty

Angioplasty and Stenting (Carotid Artery in the Neck) Click on the thumbnails to see the full size pictures.
1. pre-stent carotid stenosis: This patient had an episode of right arm weakness. The angiogram below showed a very severe narrowing of the artery supplying the left side of his brain. He was not a good candidate for surgery because of medical problems. He was then referred for angioplasty and stenting.	2. angioplasty balloon inflated in metal stent: The narrowing was open with a balloon similar to that shown below. The balloon is on the end of a tube which we place through a small hole in the artery at the hip. After opening the narrowing, we deposit a metal tube (stent) to keep the artery open. Then we dilated the stent using a second balloon (below).
3. metal stent in neck after balloon: All 4 pictures here are xrays taken from the side of the neck.This one shows the metal tube after dilation by the balloon.	4. angiogram after stent and balloon: This picture was taken after injecting x-ray contrast (dye) into a tube below where the narrowing was (compare to image 1). The vessel is now smooth, without narrowing.
Aneurysm Treatment with GDC coils
1.Pre-treatment: a small, but previously ruptured, aneurysm of the internal carotid artery.	3. Post-treatment: Soft platinum coils have been placed through a small flexible tube (micro-catheter) into the aneurysm, with the help of the balloon catheter. Blood no longer enters the aneurysm.
2. The entrance to the aneurysm was too large for the platinum coils to stay in place. A balloon (the c-shaped tube lying over the coils) was placed over the entrance to the aneurysm while the coils were placed. When the balloon was deflated, the coils remained in place.
Aneurysm Treatment with Onyx (Liquid Agent)
1.Pre-treatment: large recurrent aneurysm (view from side). This aneurysm regrew after surgical clipping and placement of GDC coils, likely due to the broad opening of the vessel at the site of the aneurysm.	2. Pre-treatment: view from the front.
3.Post-treatment (View from side): Onyx was injected into the aneurysm while a balloon was inflated in the artery to prevent blockage of the artery. Blood no longer enters the aneurysm.	4. View from the front after treatment.
5. View from the side of Onyx, coils and clips.	6. View from front.
Angioplasty (Carotid Artery in the Skull)
PET (positron emission tomography) images before and after angioplasty PET measurements of cerebral blood flow (CBF) and oxygen extraction by the brain (OEF) before (top row)and after (bottom row)angioplasty of a focal severe stenosis of an artery at the base of the brain (supraclinoid internal carotid artery). The Angiogram is shown below. Before angioplasty (top row of images) flow (CBF) is severely reduced and OEF is elevated as a compensatory mechanism to maintain normal oxygen metabolism. This condition is a proven risk factor for subsequent stroke in patients with complete occlusion of the carotid artery. The work establishing this fact was performed by the Cerebrovascular Group of the Neuroimaging lab. After angioplasty (bottom row of images) flow is improved to the extent that the OEF abnormality is reversed.
1. angiogram taken before angioplasty: This patient had episodes of weakness, leading to the angiogram. The angiogram shows a very narrowed artery supplying the right side of brain. This vessel is within the skull on the surface of the brain. The top row of PET images were made after this angiogram, before angioplasty.	2. angiogram taken after angioplasty: The narrowing is less severe and the branches beyond the narrowing fill better. The bottom row of PET images were made 36 hours after the angioplasty procedure.