Neuro-interventional radiologists are physicians with special expertise in techniques where modern imaging processes such as fluoroscopy (x-rays are taken to show real-time changes, like watching a video rather than looking at a photograph) are used to guide precise treatments for neurological (brain and nervous system) diseases.
One of the more common conditions they treat is a stroke, which is a potentially life-limiting and debilitating cerebrovascular event, i.e. an acute disease affecting the blood supply in the brain. A hemorrhagic stroke is one where the damage is caused by a bleed on the brain. This can be treated by passing a thin tube through a small incision made safely in a blood vessel elsewhere, which is navigated to the problem area guided by modern imaging techniques. Bleeds on the brain are often caused by weakened areas of the blood vessel such as aneurysms leaking blood into the tissues around the brain. These can be repaired by inserting tiny coils into the problem area, or diverting blood flow past the weakened vessel.
An ischaemic stroke is a stroke where there is damage caused by lack of blood supply to part of the brain, because of a blockage or narrowing to one of the blood vessels supplying the brain. This can also be treated by radiological intervention, a small tube again navigated via a tiny incision through a blood vessel to the narrowing or blockage, which can be used to open the vessel using a tiny balloon, inserting a stent to hold it open, or can even be used to inject a clot-busting medicine directly to the site of a blockage.
Where these kinds of interventions can be performed with minimally invasive techniques, this has become the gold standard for these procedures.
Minimally invasive procedures have a much lower incidence of pain, scarring, and other complications than traditional surgery.
A neuro-interventional radiologist usually works in a hospital, and very often with acute, urgent cases. They’re on call 24 hours a day for emergency procedures, which by necessity must be performed with great haste. This means that neuro-interventional radiologists don’t always see their patients for pre-assessments the way doctors usually do for planned procedures. Some neuro-interventional procedures can be planned, and so the doctor will have the chance to meet their patients before the procedure and discuss the risks, benefits, and options for any treatment. They will always aim to get informed consent, i.e. the agreement of the patient based on a good understanding of what the procedure involves.
Planned neurological interventions include the repair of aneurysms before they cause problems. These may have been identified on a scan of the brain; these scans may have been done because there was a suspicion of cerebrovascular problems or simply an incidental finding following a brain scan performed for other reasons.
Patients who have had neuro-interventional procedures generally recover well and quickly from the procedure itself, but often have health problems which may require a stay in a specialist inpatient unit. Very often the illness that necessitated the intervention will have created a need for monitoring or specialist rehabilitation.