Neuro Interventional Advanced Techniques and Technologies

Neuro interventional radiology is a relatively new field of medicine, pioneered in the 1980s by neuro interventional radiologists at UCSF and elsewhere. Dramatic advances in neuro interventional radiology have been possible due to improvements in medical technology, such as advanced neuroimaging and revolutionary developments in medical devices. Many medical conditions that could not be treated effectively, even 15 years ago, can now be treated and even cured, using current endovascular techniques in the skilled hands of neuro interventional radiologists at UCSF Medical Center.

As alternatives to invasive surgery, interventional methods of treatment performed by UCSF neuro interventional radiologists are advantageous because they can save lives, lower the risk to patients, shorten hospital stays, and hasten patient recovery. Endovascular techniques also allow our physicians to treat many conditions that cannot be reached with conventional open neurosurgery.

Advanced Tools

UCSF promotes innovative medical solutions and works with a number of medical device companies to offer our patients the leading medical technologies. The advanced tools utilized by the neuro interventional radiologists at UCSF include:

Stent Devices

UCSF uses a wide variety of the leading stent devices, (partial list) for example:

  • Acculink Stent for treatment of carotid stenosis
  • Enterprise Stent for treatment of wide neck aneurysms (Patient brochure by Codman Neurovascular - pdf)
  • Neuroform stent for treatment of wide neck aneurysms
  • Pipeline flow diverter for treatment of giant or dysplastic aneurysms
  • Wingspan Stent for treatment of intracranial stenosis

Embolectomy (devices for treatment of acute ischemic stroke)

  • Merci Retriever
  • Penumbra Thrombectomy Catheter
  • Stentriever (partial list: Solitaire by Covidien, Trevo by Stryker)

Embolectomy - UCSF Medical
Restoring blood flow to an artery in the brain.

Materials to Treat Cerebrovascular Disorders

  • Endovascular coils for aneurysm in the brain
  • Liquid and Particulate Embolic Agents for AVMs and Dural Fistulas
  • Stents for Atherosclerosis and Aneurysms
  • Balloons for Angioplasty
  • Sclerosing Agents for Vascular Malformations

Intra-arterial Medications

  • Thrombolytic Drugs (t-PA)
  • Chemotherapy Agents
  • Vasospasm Medications

Advanced Procedures Regularly Performed at UCSF

Endovascular Techniques

Endovascular procedures are surgeries in which a small tube known as a catheter is placed into a blood vessel in order to treat vascular disorders and other diseases.  These procedures are considered minimally invasive because they do not require an open surgical incision in the head or spine. Patients experience less pain and recover more quickly. At UCSF we receive many referrals from surgical colleagues who are aware of the benefits of endovascular approaches for patients.

Endovascular Technique - UCSF Medical
Pipeline flow diversion device to treat a giant aneurysm.

Carotid Artery Stenting (CAS)

The neuro interventional radiologists at UCSF have been performing Carotid Artery Stenting (CAS) for many years. The use of stents to treat carotid artery narrowing has become more prevalent, and “stenting” has emerged as a less invasive alternative to surgery (carotid endarterectomy). The neuro interventional radiologists at UCSF have been pioneers in investigating and treating carotid artery disease (also known as atherosclerotic disease). 

The “stenting” procedure is performed in the Neuro Interventional Radiology suite at UCSF.  There, doctors place a small catheter in the femoral artery in the leg, and guide it to the diseased segment of the carotid artery. The doctors open a small umbrella-like mechanism called an embolic protection device, which limits debris from travelling to brain blood vessels during the procedure.  Then, they place the stent inside the diseased carotid artery, and inflate a small balloon to open the blood vessel.  Once the artery is open, the umbrella is removed, and the stent remains in place to keep the blood vessel open.
Carotid Artery Stents - UCSF Medical
Successful stent placement for carotid artery narrowing.

Venous Sampling

Venous sampling is a procedure used to help localize and diagnose a problem with hormone production in the body. In this procedure, a catheter is placed into the femoral vein in the leg and is guided under X-ray visualization to the appropriate area in the body.  Blood samples are taken to evaluate those sites for specific hormonal abnormalities. The test is usually performed for two conditions: Cushing’s Disease and Hyperparathyroidism.

WADA Testing for Complex Partial Seizures

The Wada test performed at UCSF is used to evaluate language and memory function before seizure surgery or tumor resection. An angiogram is performed to evaluate the arteries within the brain before Wada testing to ensure safety. Then, the neuro interventional radiologist injects medication into the right or left internal carotid artery, in order to put one side of the brain to sleep temporarily. The patient undergoes neuropsychological testing to evaluate location of speech and memory during this interval. The process is repeated on the other side of the brain.

Angiography and WADA Testing - UCSF Medical
​Angiography and WADA testing for complex partial seizure evaluation.

Neuro Interventional Radiology Research

Patient in Research Study - UCSF Medical

Advancements in the field of neuro interventional radiology require constant development of new skills and techniques, and the neuro interventional radiology researchers within the UCSF Department of Radiology and Biomedical Imaging have been involved in designing, conducting and publishing research regarding current trends and techniques for patient care. We are focused on developing new diagnostic and endovascular treatments for disorders involving the blood vessels of the brain and spinal cord.

Hetts - UCSF Medical

In order to have access to the most current treatment options available, we work closely with the Institutional Review Board at UCSF Medical Center to oversee new products and procedures.  We work with several sponsor companies to assess the use and outcome of new intravascular stents, including Enterprise Stent, Neuroform Stent, and Pipeline Stent. We have also been involved in a multicenter study regarding outcomes after placement of carotid artery stents to treat carotid artery atherosclerotic disease. We conduct translational research in remote-controlled catheter guidance, percutaneous ablation, intraarterial chemotherapy and endovascular biopsy.  We also conduct long term clinical research on pediatric neurovascular diseases. We are working closely with other collaborators at UCSF in MRI modeling of unruptured cerebral aneurysm and MRI-assisted embolization of brain tumors.

Our angiogram suites are state-of-the-art with the ability to produce highest quality images to evaluate and treat cerebrovascular disorders.