Interventional

Most heart disease is caused by atherosclerosis, a narrowing or blocking of the coronary arteries that convey blood to the heart. A test called an angiogram can show the degree of arterial blockage by enabling the health care provider to observe the blood flow to the heart through those arteries.

In an angiogram a flexible catheter or tube is inserted into an artery, usually in the groin area, and guided through the arterial system into the heart and into the coronary arteries. A dye is then injected through the catheter into the bloodstream and x-rays of the heart and coronary arteries are taken.

Angiogram is a very effective way to show how much of the blood flow to the heart is obstructed, but it is not without risks.

Risks associated with cardiac catheterization and angiography include:

  • Sensitivity to the dyes, which could lead to infection or allergic shock
  • Excessive post-procedure bleeding from the artery that was punctured when the catheter was inserted
  • Possible shock from blood loss
  • Stroke
  • Kidney damage

As with any other diagnostic procedure, the risks associated with angiography must be viewed in light of the benefits of being able to pinpoint a potentially life-threatening blockage in a coronary artery. For a person who experiences chest pain on exertion, has a family history of heart disease, or has already had a heart attack, the benefits of an angiogram may be well worth the risks.

If you've been advised to have an angiogram, don't hesitate to ask your health care provider to explain the procedure, including any potential risks or complications. Talking about it can help you understand what the test will show and how the health care provider will use the results to develop a treatment plan that's appropriate for your medical needs.

Uterine Fibroid Embolization

Fibroid tumors are non-cancerous, benign growths that develop in the muscular wall of the uterus. They are very common, although often they are very small and cause no problems. However, from 20 to 40 percent of women age 35 and older have uterine fibroids of a significant size.

Most fibroids are diagnosed during a gynecologic internal examination. In addition an abdomen ultrasound can often confirm the presence of uterine fibroids. Additional imaging techniques such as magnetic resonance (MR) and computed tomography (CT) can help in diagnosing uterine fibroids.

Uterine Fibroid Embolization is a new non-surgical procedure that is performed while the patient is conscious but sedated-drowsy, and feeling no pain. The procedure is performed by an interventional radiologist. Stephen Lee, M.D., currently performs this procedure at INTEGRIS Baptist Medical Center.

To learn more about this procedure, call the INTEGRIS HealthLine at (405) 951-2277, Dr. Lee's office at (405) 945-4232.

Endovascular Treatment (Coiling) of Intracranial Aneurysms

What is an aneurysm?

An aneurysm is an abnormal bulging of an artery's wall. Aneurysms can occur in any part of the body, but only those affecting the arteries of the brain can cause stroke. Aneurysms cause problems in several different ways. If the aneurysm ruptures, blood flows into the brain or into a space closely surrounding the brain and this is called subarachnoid hemorrhage. It is estimated that approximately 40,000 people are diagnosed with intracranial aneurysms each year and 28,000 people suffer aneurysm rupture every year. This can be almost immediately fatal with approximately 30 percent of people dying instantly and another 20 percent of people dying within the first 30 days after subarachnoid hemorrhage. Symptoms of subarachnoid hemorrhage include "the worse headache of his or her life," nausea, vomiting, double vision, neck stiffness and occasionally loss of consciousness.

Of the survivors, approximately 50 percent will suffer permanent neurologic disability. Strokes caused by subarachnoid hemorrhage usually occur one to two weeks after the hemorrhage itself, because the blood from the hemorrhage irritates the blood vessels on the surface of the brain causing them to close (vasospasm). Treatment of patients with ruptured aneurysms usually also includes trying to prevent vasospasm to maintain blood flow to the brain and closing off the aneurysm to decrease the risk of rebleeding.

Less commonly, aneurysms can cause problems not related to bleeding. Aneurysms can form clots within the aneurysm neck, which can break away and cause stroke. Aneurysms can also press against nerves or the adjacent brain, causing multiple other symptoms.

Eventually, a non-ruptured aneurysm may enlarge and possibly bleed and a ruptured aneurysm may rebleed. Larger aneurysms rupture more often than do smaller ones.

How would someone know if they had and intracranial aneurysm?

Many unruptured aneurysms have no symptoms until they rupture. Rupture of an aneurysm is associated with the symptoms noted above including severe headache and possible loss of consciousness, nausea, vomiting. Aneurysms today can be diagnosed by magnetic residence imaging (MRI), angiography, and CT scans. Unruptured aneurysms without symptoms are often detected during MRI scanning for other symptoms.

How are aneurysms treated?

The primary goal of aneurysm treatment is to prevent future rupture or rerupture aneurysms that have already bled. In the past, surgical clipping has been the mainstay of treatment. In 1991, Guglielmi detachable coils (GDC) were introduced as an alternative method for treating selected patients with aneurysms. The goal of treatment is to prevent blood flow into the aneurysm sac by filling the aneurysm with coils. Theoretically, there are several advantages of GDC over surgery. These procedures are performed under general anesthesia with a standard transfemoral approach that is used in diagnostic angiography. In techniques similar to coronary angioplasty, a micro catheter and guide wire system are inserted into the femoral artery. The micro catheter system is threaded through the vasculature into the cerebral vessel supplying the aneurysm. Once the catheter is in position, small platinum coils are placed into the aneurysm until filled. On the average, it takes 5-7 coils to completely fill the aneurysm. Once the coils are in place, the micro catheter and guide wire are removed and the coils remain permanently within the aneurysm.

What is the Guglielmi Detachable Coil (GDC)?

The GDC is a soft platinum alloy micro coil. When properly positioned in the aneurysm, it is released into the aneurysm by application of a very low voltage current, which causes it to detach from the wire that is used to position it.

What type of doctors are trained to use the GDC system?

Interventional neuroradiologists and a few neurosurgeons trained in endovascular therapy have been trained to use the GDC system. In this country, the majority of individuals are interventional neuroradiologists These specialists employ minimally invasive procedures to reach the brain and treat a variety of diseases by the delivery of drugs, coils, balloons, and stents. They perform these procedures using guidance from fluoroscopic images.

Where is GDC Available?

In Oklahoma, Georgianne Snowden, M.D., is the first interventional radiologist trained and approved in the use of GDC. She practices in the department of Radiology at INTEGRIS Baptist Medical Center. For more information call (405) 945-4750.

Endovascular therapy continues to evolve and is in many instances the modality of choice in the therapy of intracranial aneurysms. It appears that using endovascular therapy and GDC in the treatment of this entity has improved. However, not all aneurysms can be treated by this approach, and in most instances, patients receive a neurosurgical and endovascular or interventional neuroradiology consult with best option for particular patient decided at that time.

Vertebroplasty

What You Should Know About Vertebroplasty

An Introduction to Vertebroplasty

Osteoporosis steals many things from us. Our independence. Our enjoyment in everyday activities. Our sense of well being. The National Osteoporosis Foundation predicts that 1 in 3 women past 50 will suffer a spinal fracture (referred to by doctors as a "vertebral compression fracture") as a result of the condition. While the figure for older men is better, the threat is still significant. In the mid 90s a procedure that provides relief from vertebral fractures was introduced in the United States. Called vertebroplasty, the procedure represents a major strike in our fight against osteoporosis, chance to regain the many things the condition steals away. This page's goal is to help answer the questions a patient may have about the procedure.

How does vertebroplasty work?

An easy way to think about vertebroplasty is as a cast. But instead of the cast going outside the damaged bone, the procedure places the cast inside the damaged vertebra. The patient lies on his/her stomach or side during the procedure. The area to be treated is then numbed by a local anesthetic. A fluoroscopy machine helps the doctor guide a needle into the affected bone safely. A bone cement mixture is then injected into the vertebra. Once dry, this "cast" will prevent further collapse of the vertebra and, in most cases, will provide significant relief from pain with 24 to 72 hours.

How successful is vertebroplasty?

In an initial study published in the American Journal of Neuroradiology, 80 to 90 percent of patients reported significant pain relief within 24 to 72 hours of the procedure. Among the remaining 10 to 20 percent, half received some pain relief, while the other half reported no change in their level of pain. No patient reported a worsening of pain. This rate of success has remained steady since the study. Which is why each year, vertebroplasty gains recognition as an extraordinary treatment for painful vertebral compression fractures.

What are the risks of vertebroplasty?

The major risks of vertebroplasty are mainly associated with bone cement leaking from the vertebra and into the network of veins around the spine. The lungs, the nerves around the spine, and the spinal cord itself are all areas that could be affected by such a leak. During the cement injection, continuous x-ray monitoring with fluoroscopy is used to ensure that the bone cement does not travel toward any of these areas. Infection and bleeding are risks in any surgical procedure. There have been no significant reports of either outcome after vertebroplasty. There's also a possibility of a rib fracture as the patient lies on his/her stomach during the procedure. Overall complications arise in less then one percent of vertebroplasty procedures.

Who performs vertebroplasty procedures?

F. P. Cassidy Jr. M.D., of Radiology Associates Inc.,is an interventional (surgical) radiologist. He has been performing vertebroplasty at INTEGRIS Baptist Medical Center since June of 1999. For more information, call (405) 945-4750.



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Oklahoma City, OK 73112 Phone: (405) 951-2277
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