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Cerebrovascular & Endovascular Procedures

Washington DC Vascular Neurosurgery

Vascular neurology is concerned with the blood vessels that supply the brain and nervous system. The brain is critically dependent on blood flow and can incur damage within minutes of that flow being interrupted. Atherosclerosis, or “hardening of the arteries,” can narrow blood vessels that lead to the brain or are in the brain, causing transient ischemic attacks (TIAs or “mini-strokes”), and ischemic (blocked blood vessel) stroke itself. Hemorrhagic stroke, or bleeding in the brain, can be caused by weakened blood vessels that swell like a bubble in response to blood flow (aneurysm). In recent decades, much progress has been made in treating these disorders with minimally invasive techniques.

Cartoid Endaterectomy

The most familiar cerebrovascular procedure is the carotid endarterectomy, in which excess plaque, a mixture of cholesterol, fat, and calcium, is removed from the inside of the carotid artery. The carotid arteries, one on each side of the neck, carry oxygenated blood to the brain, and are a frequent site of plaque build-up. An endarterectomy can be an open procedure, in which the carotid is surgically removed and replaced with a blood vessel graft, or is repaired with sutures. The plaque can also be removed with a surgical device called a curette, essentially a small scraping tool.

Cartoid Angioplasty

Carotid angioplasty and stenting uses a deflated balloon that is inflated when it reaches the blockage in the artery, leaving in place a stent, or mesh tube, that compresses the plaque and enlarges the blood vessel opening (lumen). Both carotid endarterectomy and angioplasty/stenting can be done by threading a wire through a major artery, such as the femoral artery in the upper thigh.

Cerebral Aneurysms

Cerebral aneurysms can be treated by clipping either side of the ballooned vessel, usually through an open surgery called a craniotomy. A minimally invasive approach called coiling, or coil embolization, can be used in selected aneurysm patients. This procedure entails placing a tiny coil in the ballooned portion of the vessel. The vessel closes around the coil, preventing rupture and bleeding of the aneurysm. As in carotid angioplasty, the coil is typically delivered through a major artery.

Cerebrovascular Procedures

Cerebrovascular procedures similar to those used to treat carotid blockage and aneurysm can also be used to treat arteriovenous malformations (AVMs), where the blood vessels appear to be a tangle of wires, or a “bag of worms.” AVMs have a risk of rupturing and causing bleeding into the brain. They can be treated angiographically, using x-rays to monitor the placement of “occlusives” or biological glues to fill the AVM and close it off from the vessels around it; like carotid angioplasty, the filler substance is delivered through an artery. AVMs, when located in an appropriate site, can also be treated with [stereotactic radiosurgery. Some AVMs are treated with the use of microsurgery, which requires a craniotomy (opening of the skull), and a microscope for the visualization of individual blood vessels.

Clinical Trials

  • WIZARD: A Randomized, Multicenter, Phase 2 Study of DSP-7888 Dosing Emulsion in Combination with Bevacizumab versus Bevacizumab Alone in Patients with Recurrent or Progressive Glioblastoma following Initial Therapy

    This is a randomized, active-controlled, multicenter, open-label, parallel groups, Phase 2 study of DSP-7888 Dosing Emulsion plus Bevacizumab versus Bevacizumab alone in patients with recurrent or progressive glioblastoma multiforme (GBM) following treatment with first line therapy consisting of surgery and radiation with or without chemotherapy. One of the primary outcome measures is to assess the effect of DSP-7888 Dosing Emulsion plus Bevacizumab versus Bevacizumab alone on the Overall Survival of patients with recurrent or progressive GBM following treatment with first line therapy consisting of surgery and radiation with or without chemotherapy.Overall survival is defined as the interval between randomization and death from any cause

  • A Double-Blind, Placebo-Controlled, Inpatient, Dose-Ranging Efficacy Study of Staccato Alprazolam (STAP-001) in Subjects with Epilepsy with a Predictable Seizure Pattern

    This is a multi-center, double-blind, randomized, parallel group, dose-ranging study to investigate the efficacy and clinical usability of STAP-001 in adult (18 years of age and older) subjects with epilepsy with a predictable seizure pattern. These subjects have an established diagnosis of focal or generalized epilepsy with a documented history of predictable seizure episodes. This is an in-patient study. The subjects will be admitted to a Clinical Research Unit (CRU) or Epilepsy Monitoring Unit (EMU) for study participation. The duration of the stay in the in-patient unit will be 2-8 days. One seizure event per subject will be treated with study medication. The duration and timing of the seizure event and occurrence of subsequent seizures will be assessed by the Staff Caregiver(s)1 through clinical observation and confirmed with video electroencephalogram (EEG).

  • Malignant Brain Tumors
    A Multicenter Study of 5-Aminolevulinic Acid (5-ALA) to Enhance Visualization of Malignant Tumor in Patients with Newly Diagnosed or Recurrent Malignant Gliomas: A Safety, Histopathology, and Correlative Biomarker Study This single arm trial is being conducted to establish the safety and efficacy of Gliolan® (5-ALA) in patients undergoing resection of newly diagnosed or recurrent malignant gliomas. The rationale for the study is that Gliolan® (5-ALA), as an adjunct to tumor resection, is safe and will provide surgeons with real-time visualization of malignant tumor.