May 7, 1999 WINSTON-SALEM, N.C. -- With a severely blocked artery in his brain, Kerry Swestyn of Winston-Salem was in danger of having a fatal stroke. The location of the blockage made surgery too risky. Less than seven years ago, the only treatment option would have been to prescribe blood thinners and hope the stroke wouldn't happen.
But new technology meant doctors at Wake Forest University Baptist Medical Center could open Swestyn's vessel without major surgery. "Now, I don't have to wake up every morning wondering if this is going to be the day," said the 45-year-old Swestyn.
A small incision was made in Swestyn's leg so a flexible tube called a catheter could be threaded through his blood vessels into his brain. Through this tube, Pearse Morris, M.D., guided the equipment to open Swestyn's artery. First, he inflated small balloons in the artery to crush the blockage. Then, he inserted a metal, scaffold-like device called a stent to help keep the artery open.
Morris, a specialist in an emerging field of medicine known as interventional neuroradiology, is among a handful of physicians in the country using stents in the brain. Four Medical Center patients have had the procedure. Stents are commonly used in the heart's arteries to keep vessels open.
The use of micro-catheters to open vessels, treat aneurysms, or deliver chemotherapy to a brain tumor is replacing conventional brain surgery in some cases. In other cases, like Swestyn's, it provides treatment options where none existed.
"This is essentially a minimally invasive form of brain surgery," said Morris.
Swestyn was able to return to work a few days after leaving the hospital. The recovery time for traditional brain surgery is several weeks and the patient may have memory problems that can last for several months.
The new type of brain "surgery" is growing rapidly because of technology that helps doctors get a better view of the vessels. The Medical Center is one of only six places in the world with equipment that provides 3-D images of the vessels.
"The quality of detail we get with the 3-D images allows us to do things that are very innovative," said Morris. "We're moving the field forward."
Another use for interventional procedures is the treatment of aneurysms, weak spots in blood vessels that could burst and cause bleeding in the brain. When aneurysms cannot be repaired surgically, micro-catheters can often be used to insert platinum coils or silicon balloons. Narrower than a human hair, the coils are placed one at a time until the aneurysm is filled, eliminating the risk of bleeding.
Because the technique has such a fast recovery time (two to three days), it is also gaining favor as an alternative to surgery in cases where either can be used. Research studies to compare the two procedures are just beginning, but in some European counties, 80 percent of aneurysms are treated with coils or balloons.
Interventional neuroradiology procedures can also be used to treat severely clogged carotid arteries in the neck. The standard procedure is surgery, called endarterectomy, to remove the lining of the vessels. For patients who aren't good candidates for the surgery, micro-catheters can be used to perform angioplasty and insert a stent.
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