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Treatment of Neurovascular Conditions

At NYU Langone’s Center for Stroke and Neurovascular Diseases, our specialists use the most advanced medical technology to identify the treatment that best matches your needs.

Among the most common medical issues we manage are cerebral aneurysms, which are caused by a weak area in the wall of an artery that supplies the brain. This weak spot bulges or balloons. The larger it becomes, the greater the risk of a dangerous or even fatal rupture.

We are also highly experienced at managing arteriovenous malformations, abnormal tangles of arteries and veins in the brain or spinal cord that can cause headaches, seizures, and, in extreme situations, bleeding or hemorrhage.

Endovascular techniques are commonly used to diagnose these conditions and for treatment. During an endovascular procedure, our surgeons access the part of the vascular system that needs to be treated through a large blood vessel.

Diagnosis Through Angiogram

During an angiogram, a contrast dye is injected through a catheter that has been inserted into a blood vessel. The dye creates a visual outline of the inside of your blood vessels, allowing doctors to see how blood flows through arteries in the neck, head, brain, and spinal cord.

A digital X-ray machine is used to take a picture. This helps us diagnose a host of conditions, including venous malformations and aneurysms.

Treatments for Aneurysms

Three endovascular techniques are most commonly used to treat people with aneurysms: balloon remodeling, intracranial stents, and flow diverters. NYU Langone experts helped pioneer the development of both intracranial stents and flow diverters.

During balloon remodeling, surgeons thread a small balloon through your blood vessels to the base of the aneurysm, which is also called the neck. The balloon creates space and gives surgeons access to the aneurysm. They then fill the bulging part of the artery with tiny metal coils. These coils fortify the walls of the aneurysm, thus reducing the chance of a dangerous rupture. After the protective coils have been placed, the balloon and catheter are removed.

Our specialists may use an intracranial stent, which is a metal tube, to treat people with aneurysms that have a complex shape. The stent provides structural support, enabling the protective coils to better strengthen the site of the aneurysm so it doesn’t burst.

A newer type of stent, called a flow diverter, is helpful in treating people with larger aneurysms. A flow diverter is a dense stent that can be used with or without coils. It provides the necessary support to reduce the risk of rupture.

Sometimes, endovascular treatment is not the best approach. Instead, direct surgical management of the aneurysm using microneurosurgery is a more appropriate option. For this procedure, doctors perform a microcraniotomy, using the most advanced interoperative imaging procedures. Microneurosurgery provides a permanent cure for this condition.

Treatment for Arteriovenous Malformation

The optimal treatment for arteriovenous malformation is direct microneurosurgery. This provides an immediate and permanent cure for this condition. This surgery is performed with the assistance of imaging guidance to specify the location and extent of the arteriovenous malformation.

Endovascular techniques are also used to treat people with arteriovenous malformations. A catheter is used to deliver a special glue to the arteriovenous malformation. This reduces blood flow through the malformation, causing it to shrink. A smaller malformation may then be managed through open microneurosurgery, performed with tiny magnifying glasses and surgical instruments, or radiosurgery.

In Gamma Knife radiosurgery, precise, high-energy beams of radiation are used to treat people with arteriovenous malformations and arteriovenous fistulas, which are abnormal pathways between arteries and veins. The goal is to completely eliminate the abnormal blood flow through the malformation, thus reducing the risk of hemorrhage, or bleeding.

Radiosurgery is of particular value to people who aren’t eligible for microsurgical tumor removal, based on the location of the arteriovenous malformation or arteriovenous fistula in the brain, other medical problems, or possible risks associated with the procedure.

Treatment for Vessel Blockage

Intracranial bypass is used when a stroke or vessel blockage results in insufficient blood supply to a region of the brain. This procedure can also be used to supply blood to the brain when a major vessel is blocked by a tumor or needs to be sacrificed in order to remove the tumor.

In this procedure, similar to heart bypass surgery, small arteries or veins are used to create a new pathway for blood to flow around the blockage or tumor. It can also be a treatment option for people with moyamoya disease—a rare condition in which the internal carotid arteries that supply blood to the brain become narrowed, limiting blood flow. Experts at our Cranial Bypass Program have years of experience performing this surgical technique in both adults and children.