Interventional Neuroradiology

John Chaloupka, MD, FAHA, FACA, Director

Introduction
Procedures Performed by the INS
Research
Fellowships
Our Faculty Physicians

Introduction
The Interventional Neuroradiology Service (INS) is a new section within the Department of Radiology at UIHC, providing the full spectrum of contemporary and emerging endovascular therapeutic and neurointerventional techniques related to the interdisciplinary practice of neurosurgery, neurology, otolaryngology, orthopedic spinal surgery, and vascular surgery. Currently, the service is enjoying 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, and a separate 24 hours/7 days a week call schedule.

The INS has excellent collaborative relationships with nationally recognized programs in Neurosurgery, Neurology, and Otolaryngology, resulting in excellent opportunities for interdisciplinary clinical care, research and education. There is also close interaction and collaboration with the Diagnostic Neuroradiology Section, which has particularly strong programs in acute stroke and cerebrovascular disease, head and neck, and advanced MR imaging.

Procedures performed by the INS include the following:
1. transarterial embolization of cerebral and spinal arteriovenous malformations (AVMs) and arteriovenous fistulae (AVFs)

2. transarterial and transvenous embolization of cranial and spinal dural AVFs

3. endosaccular embolization of intracranial aneurysms

4. temporary and permanent balloon occlusion of intracranial and brachiocephalic vessels

5. endovascular trapping of intracranial and extracranial aneurysms

6. intracranial (e.g. internal carotid, middle cerebral, vertebrobasilar arteries) percutaneous transluminal angioplasty (PTA) and stenting

7. extracranial brachiocephalic PTA and stenting (e.g. innominate, common & internal carotid, subclavian, and vertebral arteries)

8. acute thromboembolic stroke management using superselective intra-arterial chemical thrombolysis and PTA.

9. chemical and mechanical angioplasty of intracranial vasospasm

10. transarterial and direct puncture tumor embolization

11. transarterial, transvenous and direct puncture embolization of congenital and acquired AVFs and congenital AVMs

12. direct puncture sclerotherapy of low flow vascular malformations (e.g. venous malformations, lymphatic, mixed)

13. percutaneous vertebroplasty of benign and malignant vertebral compression fractures

14. combined CT and fluoroscopic guided percutaneous biopsies, drainage procedures, and therapeutic embolizations of a variety of spinal pathologies.

Research
The INS 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.

Fellowships
The INS has established a dedicated two year fellowship program for subspecialty training in the rapidly expanding fields of neuro-endovascular surgery/interventional and therapeutic 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 two staggered funded clinical fellowship positions annually, as well as opportunities for one or two year research fellowships.

The INS clinical fellows receive intensive 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, 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.

Our Faculty Physicians:

Minako Hayakawa, MD