NeuroInterventional Medicine PLLC, 406 15th Street STE M1A, Brooklyn, NY (2026)

03/27/2024

Neuroendovascular Case Study: A woman in her early 80’s presented 2 years ago with grade 3 SAH. DSA demonstrates 3 large irregular aneurysms (Left ICA Clinoid, Right ICA Ophthalmic, Right ICA pCOM). Which one Bled? We decided that the SAH pattern and Aneurysm’s morphologys were not definitive and decided to treat all 3. Using PTA Balloon Assisted Coil Embolization, which achieved greater than 90% embolization (with contrast stasis) in all of them. After extensive critical care as an inpatient, she ultimately made a Full and Complete recovery and return to Independent Life at Home and all her Activities of Daily Living. (Special Thanks to John Pile-Spellman for teaming up with me to Care for this Complex Patient!)

On Followup DSA at 2 Years, all 3 aneurysms remain well-embolized with no significant filling of the aneurysms. She continues to fully functional Independent Life and actively engages in outpatient physical therapy, exercise, as well as socializing with her fellow Seniors and enjoys reading and mahjong. Now in her mid-80’s, we will follow-up with MRA q2 years, but are confident her risks for recurrence are low.

Learning Points: Multiple Aneurysms are often observed in SAH patients. Often, it is difficult to determine which aneurysm has ruptured and is most Urgent to Treat. In these Cases, treatment of Multiple Brain Aneurysms at 1 time is occasionally required, and should be strongly considered to avoid the risks of catastrophic recurrent hemorrhages. Long term results with Coil Embolization remain very durable and achieve the goals of High Functioning Hemorrhage-Free Survival!

03/14/2024

Neuroendovascular Case Study: A man in his late 70's was experiencing a devastating Stroke secondary to Left ICA and MCA occlusion, which we were fortunate to successfully revascularize with Thrombectomy and Carotid Stenting of his Tandem Lesions (with Complete Clinical Recovery). His 3 mos CTA and Angio looked great. At 12 mos, however, he developed severe In-Stent Restenosis (ISR) of > 80%. Although asymptomatic, we elected to treat with repeat PTA using a Paclitaxel Drug Eluting Balloon (DEB), which alters the cytoskeletons in cells and irreversibly inhibits smooth muscle proliferation. 2 years after re-treatment (40 mos after initial Stroke), his Stented vessel remains widely Patent without recurrent Neointimal Hyperplasia. He remains asymptomatic and continues to be Fully Functional and Active!

Although symptomatic recurrent stenosis of Carotid Stents remains uncommon, we need to continue to diligently monitor our patients and explore innovative strategies to prevent life-threatening recurrent Strokes in these High-Risk patients. Drug Eluting Balloons have demonstrated improved Long-Term Patency in the Peripheral Vasculature as well as smaller Coronary Arteries, and remains an exciting option for these unusual high risk situations in the Cerebral Vasculature

Recent Cardiac AGENT IDE Randomized Controlled Trial Published in JAMA https://lnkd.in/epRQpc-d

01/09/2024

Neuroendovascular Case Study: A woman in her early 50's experienced Grade 3 SAH secondary to a large Anterior Communicating Artery Aneurysm, which was successfully Coiled 13 years ago. She also underwent stent-assisted Coil embolization of a second smaller wide-necked aneurysm of the Right ICA 6 mos later (felt to be unruptured). She made a dramatic recovery after her initial SAH, returning to Work and all of her Activities of Daily Living. FU angiograms at 1 year, 3 year, and 13 years demonstrated complete stable Occlusion of both Aneurysms (and more importantly, she remains symptom-free in her mid 60's!)

Learning Points: Endovascular Techniques continue to provide Stable Long-Term Symptom Free Survival in most Brain Aneurysm SAH patients, even on extended delayed FU (>10 years), confirming Real-World experiences of the Original Landmark ISAT studies.

12/14/2023

Man in his 80's with a past medical history of Hypertension, ESRD - on HD, Aortic Stenosis, Hyperlipidemia, BPH, CAD s/p stents, on Aspirin, who presents acutely after fall hitting the back of his head without loss of consciousness. Per patient for the last 2 weeks he has been having gait difficulties and freezing up of gait, he denied any previous falls. CT head revealed an acute on chronic left subdural hemorrhage measure 2.7 cm with 7 mm midline shift. On exam, Neurologically intact, although has transient dysarthria/expressive aphasia lasting less than 5 minutes x 2 over his initial 24 hours of observation.

Considering his numerous high-risk comorbidities and "Stable" Exam, we elected to perform Left Middle Meningeal Artery (MMA) Embolization with MAC rather than Surgery (with GA). Superselective Embolization of the Parietal and then Frontal Divisions of the Left MMA were performed with Embopsheres (100-300 microns) until Stasis was achieved. He remained stabled, with improved headache and Discharged to Acute Rehab for Deconditioning within a Week. On his 2 month CT follow-up, there is greater than 80% Volume reduction of the SDH with resolution of Mass Effect/Midline Shift, and he is Home functionioning Indepdently mRS 0.

Learning Points: As we gain experience with MMA embolization, we are learning that we can successfully apply this Innovative Minimally Invasive Therapeutic Strategy to a wider population of minimally symptomatic and high-risk patients, often with dramatic results, avoiding the risks of GA and Invasive Surgery in many more Patients.

Address

406 15th Street STE M1A
Brooklyn, NY
11215

Telephone

+15162666499

Website

https://neurointerventionalmedicine.com/

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