The Mount Sinai Health System offers advanced treatment options for stroke and other cerebrovascular disorders, including:
- Acute management of stroke in a dedicated acute stroke unit
- Carotid endarterectomy and stenting for treatment of carotid artery stenosis
- Micro-neurosurgical clipping of brain aneurysms
- Minimally invasive intravascular embolization of aneurysms
- Extracranial-intracranial bypass surgery for the treatment of giant and complex aneurysms, vascular occlusive disease, and Moyamoya disease
- Placement of stents and balloons inside arteries to correct problems in circulation
- Intra-operative brain mapping, transcranial Doppler and cerebral blood flow monitoring
- Specialized neurocritical care units with state-of-the-art monitoring for postoperative care
- Neuroendovascular techniques, surgery, and stereotactic radiosurgery to treat arteriovenous malformations (AVMs)
Treatment for stroke and atherosclerosis
You may be aware that heart attacks are caused by a narrowing or blockage of the coronary arteries. The same process can happen in arteries that bring blood to the brain (the carotid and vertebral arteries) or arteries within the brain itself (cerebral arteries). (cerebral atherosclerosis). Whenever any of these arteries become narrowed or blocked, your brain may not get the blood supply and oxygen it needs. The result can be an ischemic stroke or a transient ischemic attack, also known as a TIA or “ministroke.”
Doctors have traditionally treated narrowed arteries of the brain through medication, but neuroendovascular procedures are now available if medication alone fails to work. These procedures involve guiding balloons or stents up through the femoral artery in your leg toward the narrowed arteries in your brain. Upon reaching their target, the balloons are inflated or the stents expanded to prop open the narrowed passageways. With blood flow re-established, your doctor removes the balloons, leaving the stents permanently in place. You can usually go home the next morning, following overnight observation.
Acute management of stroke
Several intravenous, clot-busting medications are now available to treat strokes within just a few hours of the onset of symptoms (acute stroke). Most frequently these medications are delivered intravenously. Using neuroendovascular technology, your doctor can deliver these medications directly to the affected artery in your brain. Sometimes additional treatment strategies are needed. Other interventional approaches available include devices that physically extract (vacuum out) the clot. The Mount Sinai Stroke Center provides physicians expert in the diagnosis and management of acute stroke patients on a 24/7 basis.
Restoring blood flow through the carotid artery
Until recently, surgeons have had only one option when treating a build-up of plaque in the carotid artery — surgically removing the blockage in a procedure called endarterectomy. However, the FDA has now approved an alternative procedure, carotid artery stenting, which Mount Sinai is performing.
Carotid artery stenting is similar to the use of coronary stents in treating cardiovascular disease. After identifying the narrowed artery during an angiogram, your physician will enlarge the narrowed section with wire-mesh stents and high-pressure balloons to enlarge the narrowed segment of the vessel. This will improve blood flow to the brain and reduce the possibility of future strokes. Most patients stay overnight for observation and go home in the morning.
Several clinical trials have shown that carotid artery stenting is equivalent to or better than endarterectomy for high-risk surgical patients. Advantages of carotid artery stenting include:
- No need for general anesthesia
- Shorter procedure time
- No surgical incision
- Shorter hospital stay
- No risk of cranial nerve damage
Trials are currently underway at Mount Sinai to determine whether carotid artery stenting is safe and effective for low- to moderate-risk patients.
Treatment of arteriovenous malformations (AVMs)
At Mount Sinai, we use a multidisciplinary approach to treat abnormal connections between arteries and veins (arteriovenous malformations or AVMs) in the brain or spine. Although some AVMs may never cause trouble, others require treatment to prevent hemorrhage, seizures, or other neurologic symptoms.
We treat AVMs in three ways:
- Neuroendovascular techniques to stop the abnormal blood flow between arteries and veins
- Surgery to remove the AVM
- Radiosurgery to eliminate the AVM
We use a minimally invasive neuroendovascular technique called embolization to close the AVM from the inside, using “glues” or particles. Although this technique can close the entire abnormality in some patients, for others, the malformation may need to be surgically removed or treated with a special type of radiation (radiosurgery). In these cases, embolization prior to either of these approaches can shrink the malformation and reduce the risk of bleeding if surgical removal is required.
If surgery is required, we use the most advanced techniques, including microsurgery, brain mapping, and awake craniotomy, to remove the AVM while preserving surrounding brain tissue.
For AVMs that are inoperable, we can use focused radiation beams (stereotactic radiosurgery) to reduce their size or eliminate them entirely. Stereotactic radiosurgery may also be the treatment of choice for patients who cannot or will not undergo open surgery.
We can help
Mount Sinai’s cerebrovascular team offers the most advanced diagnostic and treatment options. Call us at 212-241-3457 to schedule an appointment. Our office is conveniently located on the Upper East Side of New York City.