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The University
of Iowa Hospitals and Clinics has approximately 900 beds
and is closely allied with a 200-bed Veterans Administration Hospital
on the same grounds. Both hospitals serve as major referral centers
for the Midwest. The Department
of Radiology consists of 64 staff physicians and 36 residents.
Last year these hospitals performed approximately 291,000 radiological
examinations.
The
Interventional Neuroradiology Service (INS) is the newest Section
within the Department of Radiology at UIHC, having been established
in late 1998 with the recruitment of Dr. John C. Chaloupka from
Yale University. Within a very short period of time, Dr. Chaloupka
has developed a world-class program centered upon providing the
full spectrum of contemporary and emerging techniques in endovascular
surgery and image-guided neurointervention related to the interdisciplinary
practice of neurosurgery, neurology, otolaryngology, orthopedic
spinal surgery, and vascular surgery. The clinical service currently
is the busiest in the Midwest, and sixth busiest in the entire nation,
performing over 480 neurointerventional cases per year. The Service
enjoys exceptional strengths in the management of aneurysms, AVMs,
intracranial & extracranial occlusive disease, acute thrombo-embolic
stroke, and otolaryngologic disease.
The INS has direct patient
care responsibilities involving the endovascular surgical approaches
to diseases of the brain, spinal cord, head & neck, and spine. These
responsibilities include not only the performance of various neuro-interventional
and therapeutic procedures, but also daily (including weekends)
clinical rounding, post-operative management of patients, a separate
24 hours/7 days a week call schedule, and a busy outpatient clinic
(for both initial encounters and postoperative follow-ups).
The INS has excellent collaborative
relationships with nationally recognized programs in Neurosurgery,
Neurology, Otolaryngology, and Neuro-Ophthalmology, resulting in
excellent opportunities for interdisciplinary clinical care, research
and education.
Procedures performed by
the INS include the following:
- diagnostic selective and
superselective catheter angiography of the brain, head & neck,
and spinal cord
- transarterial embolization
of cerebral and spinal arteriovenous malformations (AVMs) and
arteriovenous fistulae (AVFs) using ultra-superselective injection
of cyanoacrylate
- transarterial and transvenous
embolization of cranial and spinal dural AVFs
- endosaccular embolization
of intracranial aneurysms using detachable coils, liquid embolics,
and hybrid devices
- temporary (provocative
testing), and permanent balloon occlusion of intracranial and
brachiocephalic vessels for the management of carotid blowout
syndrome, cranial base tumors, and giant aneurysms.
- selective and superselective
intra-arterial provocative testing of eloquent neurologic function
(e.g. carotid, middle cerebral, posterior cerebral & anterior
cerebral artery Wada tests)
- endovascular trapping of
intracranial and extracranial aneurysms
- percutaneous transluminal
angioplasty (PTA) and stenting of intracranial cerebral arteries
(e.g. internal carotid, middle cerebral, vertebrobasilar arteries)
- PTA and stenting of extracranial
cerebral arteries (e.g. innominate, common & internal carotid,
subclavian, and vertebral arteries)
- PTA and stenting of the
intracranial dural sinuses for the treatment of acute and chronic
cerebral venous occlusive disease
- acute thromboembolic stroke
management using superselective intra-arterial chemical (e.g.
tPA) and mechanical (e.g. PTA) thrombolysis
- chemical (Ia papaverine)
and mechanical (PTA) angioplasty of intracranial vasospasm
- intra-arterial chemotherapy
for brain tumors (primary and metastatic) and otolaryngologic
tumors; Intra-arterial gene therapies are planned in the near
future
- transarterial and direct
puncture embolization of both intracranial and head & neck tumors
using particulate and liquid embolic agents
- transarterial, transvenous
and direct puncture embolization of congenital and acquired AVFs
and congenital AVMs
- direct puncture sclerotherapy
of low flow vascular malformations (e.g. venous malformations,
lymphatic, mixed)
- percutaneous vertebroplasty
of benign and malignant vertebral compression fractures
- combined CT and fluoroscopic
guided percutaneous biopsies, drainage procedures, and therapeutic
embolizations of various spinal column pathologies.
The Section of Interventional
Neuroradiology has an active research program with numerous on-going
and planned clinical and laboratory projects. These include computer
modeling and fluid mechanics analysis of aneurysms, AVMs, & carotid
stenoses, neuro-endovascular micro-device development, image guided
intervention, pathophysiologic relationships between angiogenesis
& cerebrovascular disease, technical/technological innovations,
and feasibility, efficacy & outcomes analysis of endovascular surgical
approaches to neurovascular dieases. Excellent laboratory facilities
also are available for various investigations in advanced imaging
science, image guided intervention and therapy, functional MR imaging,
and in vitro & in vivo modeling of cerebrovascular disease. We have
established a hemodynamics/fluid mechanics laboratory located in
the Medical Research Center (MRC 508) that is currently staffed
by a full time research assistant and a few part time medical students
and clinical fellows. There are plans for expansion in the near
future to include engineering graduate students (masters, doctorate,
and postdoctorate) and more dedicated research fellows (clinical
and research M.D. and/or Ph.D). This laboratory currently is conducting
hemodynamic modeling and mechanics analysis of various types of
cerebrovascular diseases (e.g. AVMs, aneurysms, circle of Willis
occlusion) for the purpose of developing new endovascular surgical
devices/ techniques, and the elucidation of important pathophysiologic
phenomena that may be relevant to the practice of Interventional
Neuroradiology.
Through the assistance of
a shared core research facility within the Cardiovascular Research
Center [5th floor, MRC], we also have developed an in vivo laboratory
for both research and development of new neuro-interventional technology,
and the study of pathophysiologic mechanisms of cerebrovascular
diseases (such as AVMs, dural arteriovenous fistulae and intracranial
aneurysms) using several different animal models.
The Section of Interventional
Neuroradiology offers a dedicated two-year clinical fellowship program
for subspecialty training in the rapidly expanding field of neuro-endovascular
surgery/interventional neuroradiology. Prospective candidates will
be considered for admission to this program from accredited residencies
in either Radiology or Neurosurgery, and is contingent upon successful
completion of either program, and in the case of candidates applying
from Radiology programs, successful completion of at least one year
subspecialty fellowship training in Diagnostic Neuroradiology. Candidates
for these positions must have a strong commitment to an academic
career with demonstrated interest and ability in clinical care,
research and teaching. There are 2-3 staggered funded clinical fellowship
positions annually, as well as opportunities for one- or two-year
research fellowships.
The Interventional Neuroradiology
clinical fellows receive intensive clinical training and supervision
in performing the above mentioned endovascular/interventional techniques,
through daily participation in case referrals. Of equal importance,
the fellowship training also emphasizes proper clinical and imaging
diagnostic work up, physical examination, therapeutic decision making,
complication avoidance and intervention, preoperative and postoperative
clinical management, and interdisciplinary therapeutic strategies.
These objectives are accomplished through the following activities:
daily work and teaching rounds, participation in various weekly
teaching conferences (e.g. neurosurgery M&M, otolaryngology tumor
board, neuro-indications-neuroscience conference, neurointerventional
case conference, etc.), and various rotations on clinical neuroscience
and otolaryngology services.
In addition to the above
described intensive clinical training, the INS fellows are required
to participate in ongoing clinical, translational, and basic science
research projects conducted by the INS and/or its interdisciplinary
collaborations. Fellows are encouraged and supported for independently
initiated research. Appropriate mentoring for such academic activities,
such as formulating hypothesis driven investigations, developing
project protocols/budgets, project execution and analysis, and the
production of scientific publications and presentations is provided.
Successfully matriculating
trainees under Dr. Chaloupka's mentoring have consistently obtained
excellent academic appointments at prestigious institutions, including:
Harvard (Massachusetts General Hospital), Yale, and Columbia Universities,
and the University of Pennsylvania.
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