Neuro Interventional Radiology Treatment of Diseases

The neuro interventional radiology physicians at UCSF perform advanced techniques to diagnose and/or treat the following:

Acute Stroke

Stroke is the third leading cause of death in the United States, after cardiovascular disease and cancer.  Strokes disable more adults than any other condition.  When a stroke occurs, a blood vessel in the brain becomes blocked or bursts, sometimes causing permanent brain damage or even death. However, prompt treatment and follow-up care may protect brain cells and help patients lead healthy, productive lives. There are several symptoms particular to stroke. Any of these symptoms should motivate a call to 911 immediately:

  • Drooping on one side of the face, especially when the person tries to smile.
  • Pronounced weakness on one side of the body.
  • When the person lifts both arms, one arm seems to drift down.
  • Slurred speech.
  • Some people experience a sharp, jabbing headache, but not everyone does.

Speed is the key to effective stroke treatment - the faster doctors can restore blood flow to the brain, the better their chances of preventing brain damage.

Acute Stroke Treatment - UCSF Medical
Stent Retriever device removes a bloot clot in acute ischemic stroke.

Acute Stroke - Ischemic Stroke

Ischemic stroke accounts for approximately 80 to 85 percent of all strokes.  In ischemic stroke, the blood supply to a part of the brain becomes blocked.  This prevents oxygen and nutrients from reaching brain cells. Within a few minutes, these cells may begin to die.  Ischemic stroke is a life-threatening condition that UCSF’s neuro interventional radiologists skillfully treat.  Our neuro interventional radiology physicians may be able to navigate a catheter to the site of the blockage in the blood vessel, and to deliver clot dissolving medication such as tissue plasminogen activator (t-PA). Removal of the clot (mechanical thrombectomy) may also be achieved using a variety of clot removal devices. The goal is to restore blood flow through the blocked artey and to minimize the effects of the stroke.  These treatments should be performed as soon as possible after the onset of the stroke.  The sooner treatment is started, the better the outcome.

Halbach Treating Infant - UCSF Medical
​Dr. Van Halbach successfully treating a one-day-old infant with a enormous aterial venous fistula.  If untreated, this condition has a mortality rate of 95%.

Acute Stroke - Hemorrhagic Stroke

During a hemorrhagic stroke, a blood vessel within the brain leaks or ruptures, and bleeds into the brain tissue (intra-cerebral hemorrhage) or into the surrounding space (subarachnoid hemorrhage).  This can exert pressure on the brain and cause neurological deficit. The UCSF neuro interventional radiologists will perform an angiogram with the goal of identifying the cause of the bleeding, and, if possible, stop the source of bleeding by a technique called embolization.

Brain Aneurysm and Subarachnoid Hemorrhage (SAH)

An aneurysm is a weakened area in a blood vessel that may enlarge and rupture.  Approximately eight to ten percent of all strokes are caused by ruptured brain aneurysms.  Aneurysms can be treated by surgery or by endovascular techniques, including insertion of platinum coils into the aneurysm or placement of flow divertering stents to stop blood flow to the aneurysm.  These methods may help prevent rupture or re-rupture of the aneurysm.

A ruptured aneurysm causes SAH, which is bleeding into the space between the brain and its surrounding thin tissues. A person who has had an SAH typically describes it as “the worst headache of my life!”  The headache typically comes on suddenly and without warning.

Aneurysm in The Brain - UCSF Medical
Coiling to treat ruptured cerebral aneurysm.

Aneurysms are often found in typical locations along the brain arteries. Some factors that may correlate with an increased risk of bleeding include:

  • Size - larger aneurysms have a higher tendency to bleed
  • High blood pressure
  • Cigarette smoking
  • Heavy alcohol use
  • Family history
  • Drug abuse

Once a cerebral brain aneurysm is suspected, UCSF neuro interventional radiologists can perform a diagnostic angiogram to fully evaluate the location and size of the aneurysm, and to determine if the aneurysm is suitable for treatment by endovascular coiling.  The majority of brain aneurysms can be treated using these endovascular techinques, in which a very small catheter is navigated to the aneurysm through the brain blood vessels under direct X-ray visualization. Platinum coils are then directed through the catheter and are placed into the aneurysm to prevent rupture or re-rupture. ​

Arteriovenous Malformations (AVMs)

A brain AVM is an abnormal tangle of blood vessels which causes rapid shunting of blood from arteries to veins.  AVMs are congenital (present from birth).  Symptoms may vary and include headaches, pain, seizures, noise (bruit), and sometimes bleeding and stroke.

AVMs can be treated by UCSF’s neuro interventional radiologists, who advance a microcatheter through the feeding artery into the AVM. A variety of embolic materials (including acrylic glue, Onyx, particles, and coils) may be injected to block the AVM from filling.  UCSF physicians have pioneered many of the devices and treatments used for the treatment of AVMs.

Ruptured AVM - UCSF Medical
Glue embolization of a ruptured AVM.

Birthmarks and Vascular Malformations

Vascular birthmarks are comprised of abnormal blood vessels that can occur on the face, head, neck, or other parts of the body, both internally and externally.  They are thought to be congenital (present from birth), but some may not be noticed until later in life. Vascular birthmarks consist of either benign tumors (such as hemangiomas) or malformed blood vessels (vascular malformations).  UCSF is home to the Birthmarks and Vascular Anomalies Center of Northern California (BVAC), an internationally renowned center for the diagnosis and treatment of these complex lesions.

Dowd & UCSF Team - UCSF Medical
Dr. Christopher Dowd with the other members of the
UCSF Birthmarks and Vascular Anomalies Center.

Since 1991, the BVAC has provided comprehensive, multidisciplinary, specialized treatment of birthmarks and vascular anomalies in children and adults.  Our specialists (including neuro interventional radiologist Christopher Dowd, MD, who is a co-founder and co-director and who has been involved since the center’s inception) have evaluated and treated thousands of individuals with vascular anomalies.  BVAC is equipped to handle the full range of birthmarks and vascular anomalies through state-of-the-art evaluation and treatments including embolization, sclerotherapy, surgery, laser therapy, medical management, education, and counseling.  Birthmark & Vascular Anomalies Center

Brain Tumors – Pre-Operative Embolization

A brain tumor is an abnormal growth of tissue that occurs either within the brain covering (dura mater) or within the brain itself.  There are many different types of brain tumors, and at UCSF each tumor is treated uniquely.  A meningioma is a common type of benign brain tumor which may have abundant blood supply and which may have been growing slowly for a long time.

A cerebral angiogram may be performed to evaluate the extent of the blood supply to the meningioma.  If the tumor is highly vascular, pre-operative embolization can be performed by UCSF neuro interventional radiologists to reduce blood flow to the tumor.  This may improve surgical outcome, by permitting easier and faster tumor resection with reduced blood loss.

Meningioma Treatment - UCSF Medical
Meningioma undergoing preoperative embolization.

Carotid Artery Disease and Stenosis

A common cause of stroke is carotid artery disease (CAD), also known as carotid artery stenosis. This results from a build up of atherosclerotic plaque in the carotid artery in the neck which causes aterial narrowing or stenosis.  Risk factors for atherosclerosis include:

  • Hypertension
  • Diabetes
  • High cholesterol
  • Smoking
  • Genetic predisposition
  • Obesity

Carotid atherosclerosis can cause a stroke either by critically reducing blood flow to the brain (ischemic stroke) or by dislodging a piece of plaque which travels into the brain blood vessels (embolic stroke). The severity of the stroke depends on the degree of blood flow limitation and on the part of the brain affected.  Interventional therapy to treat carotid artery disease can be performed by Carotid Artery Stenting (CAS), a procedure in which the narrowed carotid artery is reopened by placement of a stent.

Dissection of Carotid and Vertebral Arteries

A dissection is a tear of the inner lining ("intima") of the blood vessel wall.  This can occur from trauma, extreme twisting or turning of the neck, a penetrating injury, a congenital weakness of the blood vessels, or spontaneously. A dissection can lead to a stroke, either by forming clots that break off and migrate to blood vessels in the brain, or by narrowing the blood vessel resulting in inadequate blood flow to the brain.

Dissections can also result in aneurysm formation due to weakening of the blood vessel wall.  Dissections can be treated by intravascular stenting, to “bridge” the area of the damaged blood vessel and to restore the normal blood flow, which will then decrease the risk of additional strokes.

Aneurysm Treatment - UCSF Medical

Dural Arteriovenous Fistula (DAVF)

DAVF Imaging - UCSF MedicalA dural arteriovenous fistula (DAVF) is an acquired abnormal connection between arteries and veins within the dura mater which lines the surface of the brain and spinal cord. These abnormal connections divert normal blood flow into veins causing increased venous pressure.  This may lead to pain, headaches, visual symptoms, noise (bruit), and can result in bleeding or stroke. UCSF’s neuro interventional radiologists use embolization techniques to reduce or eliminate blood flow to the DAVF using specially designed glues, spheres, or coils. UCSF is the premiere center for the diagnosis and endovascular management of this disease.  Many definitive treatments, including transvenous treatments, were pioneered at this institution.

Treatment of Ruptured DAVF - UCSF Medical
Endovascular cure of a ruptured dural A-V fistula using Onyx.

Intracranial Atherosclerosis

Intracranial Atherosclerotic Disease (ICAD) is a narrowing ("hardening") of the arteries within the brain. ICAD carries a very high incidence of stroke. Risk factors for development of ICAD are the same as those which produce carotid artery stenosis. Intracranial atherosclerosis can be evaluated by CT angiography, MR angiography, transcranial doppler ultrasound, and catheter angiography. Treatment may include medical management (aspirin or other antiplatelet medications, blood pressure medications, and statins) or endovascular treatment using angioplasty and stenting.

Intracranial atherosclerosis (ICAD)
Angioplasty and stenting to open a high-grade narrowing in the basilar artery.

Pulsatile Tinnitus

Tinnitus is the sensation of hearing a sound that does not have an external source, and pulsatile tinnitus is the sensation of hearing a rhythmic sound without that external source. Pulsatile tinnitus may be due to an underlying tumor, or vascular problem.  The UCSF Pulsatile Tinnitus Clinic is a multidisciplinary team comprised of physicians and researchers from the departments of Radiology, Neurology, and Psychiatry who all specialize in the diagnosis, treatment and research of patients with pulsatile tinnitus of various etiologies.  Learn more

Retinoblastomas

A retinoblastoma is a rare cancer of one or both eyes that occurs in infants and young children, and is caused by a genetic defect.  This tumor affects both boys and girls of all races. "Staging" the tumor is the process of finding out where and how much a cancer has spread.  This is accomplished by eye examinations, imaging tests (MRI), and biopsy (taking a sample of the tumor).

Treatment may consist of intravenous chemotherapy, surgery, radiation, or the new technique of intraarterial chemo-infusion. In appropriate patients, UCSF neuro interventional radiologists can perform intraarterial chemo-infusion by directing a microcatheter into the ophthalmic artery to the affected eye, and infusing a chemotherapeutic drug directly to the tumor. Referral for this therapy is made by ophthalmologists who specialize in diagnosing this disorder at the UCSF Neuro-Ophthalmology center.

pediatric retinoblastoma
Illustration of retinoblastoma.

Spinal AVMs and Spinal DAVFs

Spinal AVMs and spinal DAVFs are conditions in which there is an abnormal connection between arteries and veins within (SAVM) or on the surface of (SDAVF) the spinal cord. Symtoms may include loss of motor function or sensation of the legs or arms, bowel and bladder problems, and pain. Evaluation requires a neurological examination, spinal MRI, and usually a spinal angiogram. Treatment is either by surgery or by embolization. UCSF neuro interventional radiologists can disconnect these abnormal connections by blocking the blood supply with acrylic glue.

Dr. Steven Hetts and Dr. Daniel Cooke
​Dr. Steven Hetts and Dr. Daniel Cooke are advancing neuro interventional radiology through advances in research translated to clinical practice.

Cushing’s Syndrome

Cushing’s Syndrome is a clinical state resulting from an elevated level of glucocorticoid hormone in the body.  While the most common cause of Cushing’s Syndrome is related to the use of oral steroids, adrenocorticotropin hormone (ACTH) secretion by the body is among the internal causes of Cushing’s Syndrome.  Eighty-five percent of cases of abnormal ACTH secretion is caused by a benign pituitary tumor, a condition known as "Cushing’s Disease".  Alternatively, Cushing's Syndrome may result from production of ACTH by non-pituitary tumors (Ectopic ACTH Syndrome).

Because the best treatment of Cushing’s Disease is surgical removal of the ACTH-producing pituitary tumor, the referring doctor needs to confirm the source of the ACTH production.  Localized venous sampling was developed to improve the diagnostic accuracy in distinguishing pituitary from ectopic sources of ACTH, and UCSF neuro interventional radiologists are experts in performing this prodedure.

Neuro interventional technology
Dr. Dowd and Dr. Halbach reviewing a patient's anatomy.

Hyperparathyroidism

Hyperparathyroidism is a condition in which there is overproduction of parathyroid hormone, an essensial element of calcium metabolism. It is usually caused by a small adenoma or benign tumor in the parathyroid gland, neck, or upper chest. This condiiton can result in weakened bones and fractures.  It is necessary to identify the source of the hormone so that the adenoma can be removed surgically. This can be accomplished by advanced imaging techniques or by selective venous sampling, performed expertly by UCSF neuro interventional radiologists

Complex Partial Seizure

A complex partial seizure represents a transient alteration in consciousness combined with abnormal motor activity, resulting from abnormal electrical activity of the brain, usually in the temporal lobe.  This condition can be treated by anti-seizure medications or by surgery. Prior to surgery, it is important to evaluate the location of speech and memory functions in the brain so as not to disrupt these functions as a result of surgery. UCSF neuro interventional radiologists are experts in performing a pre-operative Wada test to evaluate speech and memory location.