Endovascular Surgery and Neurointervention in Delhi
Endovascular surgery and neurointervention use imaging and fine catheters to diagnose and treat selected conditions affecting the blood vessels of the brain, neck and spinal cord. These techniques allow treatment from inside the blood vessels, often without opening the skull.
Dr. Tushar Sharma, Brain, Spine and Endovascular Neurosurgeon, provides consultation for patients with neurovascular conditions. Assessment focuses on understanding the diagnosis, reviewing scans and discussing suitable treatment options.
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Understanding Endovascular Surgery and Neurointervention
The term endovascular means inside a blood vessel. A thin, flexible tube called a catheter is usually introduced through an artery in the groin or wrist. Using live X-ray images, the specialist guides it towards the area requiring investigation or treatment.
Neurointervention includes procedures that remove blood clots, close abnormal blood vessel connections or treat certain aneurysms. Some procedures are planned after assessment, while others are performed as emergency treatment.
Conditions that may be treated
Endovascular techniques are used for selected conditions of the blood vessels of the brain, neck and spinal cord.
Brain Aneurysms
A brain aneurysm is a bulge in a weakened part of an artery. If it ruptures, it can cause bleeding around the brain. Treatment options for suitable aneurysms include coiling, sometimes with stent assistance, and flow diversion. Coils help seal the aneurysm from within; a flow diverter redirects blood along the artery and reduces flow into the aneurysm.
Acute Ischaemic Stroke
An ischaemic stroke occurs when a clot blocks blood supply to part of the brain. Selected patients with a blockage in a major artery may benefit from mechanical thrombectomy, which removes the clot through a catheter. Eligibility depends on urgent clinical assessment, brain imaging and the time since symptoms began. Treatment must be assessed without delay.
Brain Arteriovenous Malformations
An arteriovenous malformation, or AVM, is an abnormal tangle of blood vessels connecting arteries and veins. Endovascular embolisation uses specialised materials to block selected abnormal vessels. It may form part of a treatment plan that also includes surgery or stereotactic radiosurgery. Some AVMs are monitored rather than treated immediately.
Dural Arteriovenous Fistulas
A dural arteriovenous fistula is an abnormal connection between arteries and veins within the covering of the brain or spinal cord. Embolisation may close the connection using coils or a specialised liquid material. Treatment planning depends on the fistula's anatomy, blood drainage pattern and associated risks.
Carotid Artery Narrowing
The carotid arteries supply blood to the brain. In selected patients, significant narrowing may be treated with angioplasty and stenting to widen the artery and help keep it open. Whether a procedure is appropriate depends on symptoms, imaging and an assessment of its benefits and risks.
Assessment and treatment planning
Assessment includes a review of symptoms, medical history, current medicines and previous scans. Depending on the suspected condition, investigations may include:
- CT scan
- MRI
- CT angiography
- MR angiography
- Digital subtraction angiography (DSA)
Digital subtraction angiography, or DSA, may be recommended when a more detailed view of the blood vessels is needed. It can help identify an aneurysm, map abnormal connections and guide treatment planning. A diagnostic angiogram does not automatically mean that treatment will be performed during the same session.
The treatment decision considers the condition's location and anatomy, whether bleeding has occurred, the patient's overall health and the risks of intervention. Options may include:
- Observation
- Medicines
- Endovascular treatment
- Open surgery
- A combination of approaches
What happens during the procedure
Before a planned procedure, the team explains its purpose, alternatives and possible complications. Patients receive instructions about fasting and medicines and should report any contrast allergy, kidney condition or possibility of pregnancy.
The procedure takes place in an angiography suite under local anaesthesia with sedation or general anaesthesia, depending on the treatment and the patient's condition.
AccessA blood vessel is accessed, usually in the groin or wrist
GuidanceA catheter, contrast dye and X-ray guidance are used to reach the target
TreatmentThe planned treatment is performed
Closure & monitoringThe catheter is removed, the entry site is secured and monitoring continues
Benefits
For suitable patients, endovascular treatment can reach a blood vessel problem through a small access site and avoid a skull opening. Recovery may be shorter than after some open operations, but the underlying condition strongly influences the outcome.
- Small access site
- Often avoids a skull opening
- Recovery may be shorter than after some open operations
Possible risks
Possible complications include:
- Bleeding or bruising at the entry site
- Blood vessel injury
- Contrast reactions
- Blood clots
- Stroke or bleeding in the brain
Serious complications can cause lasting neurological disability and, rarely, death. Individual risks vary with the procedure and the patient's health and should be discussed before treatment.
Recovery and follow up
Recovery depends on the condition treated, the procedure and whether a stroke or brain haemorrhage occurred beforehand.
Planned procedures
Some planned procedures involve a short hospital stay.
Emergency cases
Emergency cases may need intensive monitoring and rehabilitation.
Follow-up may include scans to assess the treated blood vessel and check for recurrence or changes. Patients receive guidance about medicines, activity and returning to work. Take prescribed medicines as directed and discuss any changes with the treating team.
Symptoms that need emergency care
The following need immediate medical attention:
- Sudden facial drooping
- Arm or leg weakness
- Difficulty speaking
- Loss of vision
- Sudden severe headache
Suspect a stroke? Stroke symptoms still need urgent assessment even if they improve. Seek emergency care immediately rather than waiting for a routine clinic appointment, or call an ambulance on 112. Do not drive yourself to hospital if a stroke is suspected.
Frequently asked questions
Does every brain aneurysm need a procedure?
No. Some unruptured aneurysms are monitored with follow-up imaging. The decision depends on their features, the likelihood of rupture and the risks of treatment.
Can neurointervention treat every type of stroke?
No. Mechanical thrombectomy is used for selected strokes caused by a blocked artery. Stroke caused by bleeding requires a different assessment and treatment plan.
Is endovascular treatment always better than open surgery?
No. The appropriate approach depends on the diagnosis and blood vessel anatomy. Open surgery, observation or a combination of treatments may be more suitable in some cases.
Will I need further scans after treatment?
Often, yes. Follow-up imaging helps assess the result and identify changes that may need further attention. The type and timing of scans depend on the condition and procedure.
Can I get a second opinion about my treatment options?
A consultation can help you understand the diagnosis and proposed treatment. Bring your original scan images, reports, previous treatment records and current medicine list.
This page is for general information and does not replace a personal medical consultation. In an emergency, go to the nearest hospital immediately. Treatment and recovery vary from patient to patient.
Consult Dr. Tushar Sharma
For an assessment of a diagnosed or suspected neurovascular condition, schedule a consultation with Dr. Tushar Sharma in Delhi. Review your reports, understand the available options and discuss whether endovascular surgery or another approach is appropriate for your condition.