A lot of conditions that used to require major open surgery can now be treated this way, often with a shorter hospital stay and a faster recovery. Below are five conditions our Endovascular Services & Care team treats regularly, along with what each one involves.
Carotid Artery Narrowing (Carotid Artery Stenosis)
The carotid arteries run up either side of your neck and supply blood to your brain. Over time, plaque can build up inside these vessels and narrow them, a condition called carotid artery stenosis.
This matters because narrowed carotid arteries are one of the leading causes of stroke. Plaque can break off and travel to the brain, or the artery can narrow enough to restrict blood flow on its own. The tricky part is that carotid artery narrowing often causes no symptoms at all until a stroke or TIA (a “mini stroke”) happens.
For patients who need treatment, carotid artery stenting offers a minimally invasive alternative to carotid endarterectomy, the traditional open surgery. A small stent is placed inside the artery to hold it open and restore normal blood flow.
Arteriovenous Malformations (AVMs)
An arteriovenous malformation is an abnormal tangle of blood vessels where arteries connect directly to veins, skipping the capillaries that normally slow blood flow down between them. Most AVMs are congenital, meaning a person is born with one, and many are found by accident during imaging for an unrelated issue.
The risk with an AVM is that the abnormal, high-pressure connection can bleed. Depending on size and location, an AVM can also cause seizures or other neurological symptoms.
Treatment typically involves embolization, where the surgeon threads a catheter to the AVM and blocks off its blood supply. This can eliminate the malformation entirely or shrink it enough to make follow-up treatment, like radiation or surgery, safer and more effective.
Dural Arteriovenous Fistulas (DAVFs)
A dural arteriovenous fistula is similar in concept to an AVM, but the abnormal connection forms in the dura, the tough outer membrane that covers the brain, rather than within the brain tissue itself. It’s a distinct condition with its own set of risks.
Patients with a DAVF often notice pulsatile tinnitus, a whooshing or thumping sound in the ear that matches their heartbeat. Headaches and vision changes are common too. Left untreated, a DAVF carries a risk of bleeding.
As with AVMs, embolization is the go-to treatment. The surgeon closes off the abnormal connection through the blood vessels, which resolves the fistula without open surgery.
Vascular Tumors
Some tumors in or near the brain and spine develop a rich blood supply of their own, which can make surgical removal riskier due to bleeding. This is where endovascular care plays a supporting role.
Before a surgeon removes a vascular tumor, an endovascular surgeon can perform pre-surgical embolization to cut off much of the tumor’s blood supply. That makes the operation safer and often shorter. In some cases, embolization alone is used as a standalone treatment, particularly for tumors that aren’t good candidates for surgical removal.
General Vascular Disorders of the Brain, Neck, and Spine
The five conditions above are common reasons patients see an endovascular surgeon, but they’re not the whole picture. Our team also treats brain aneurysms and performs mechanical thrombectomy for stroke patients, along with other vascular malformations and blood vessel abnormalities affecting the brain, neck, and spine.
If a condition involves the blood vessels supplying the brain or spine, there’s a good chance it falls within endovascular surgery’s scope, even if it isn’t listed here specifically.
When to Talk to a Specialist
Because several of these conditions cause few or no symptoms until something serious happens, it’s worth mentioning the following to your doctor if you notice them:
- Sudden or severe headaches
- Vision changes
- Pulsatile tinnitus (a whooshing sound in the ear timed with your heartbeat)
- Numbness, weakness, or difficulty speaking, even if it passes quickly
That last one in particular can be a sign of a TIA and shouldn’t wait; go to the emergency room if you experience numbness, weakness, or difficulty speaking. Your primary care provider can refer you to our team, and depending on your condition, a direct evaluation may be available as well.
If you’re ready to get evaluated, request an appointment with our endovascular team.
Frequently Asked Questions
Is endovascular surgery the same as neurosurgery?
Not exactly. Endovascular surgery, also called interventional neuroradiology, is a subspecialty that treats vascular conditions of the brain, neck, and spine through catheter-based, minimally invasive techniques rather than open surgery. Endovascular surgeons often work alongside traditional neurosurgeons, and in some cases a patient’s treatment plan may involve both.
How long is recovery from these procedures?
Recovery time varies by procedure and by the individual’s condition, but minimally invasive treatments generally involve shorter hospital stays and quicker returns to normal activity than open surgery. Many patients go home within a day or two, though your care team will give you a recovery timeline specific to your procedure.
Are these conditions usually found by accident, or do they cause symptoms?
It depends on the condition. Carotid artery narrowing is often silent until it causes a TIA or stroke, and AVMs are sometimes discovered incidentally during imaging for an unrelated issue. Others, like dural arteriovenous fistulas, more commonly cause noticeable symptoms such as pulsatile tinnitus or headaches that prompt someone to seek care. Because some of these conditions can be symptom-free, imaging and a thorough evaluation are important when risk factors are present.
Who is a candidate for minimally invasive treatment versus open surgery?
Candidacy depends on factors like the size, location, and complexity of the condition, as well as a patient’s overall health. An endovascular surgeon will review imaging and diagnostic tests to determine whether a catheter-based approach is appropriate or whether open surgery offers a better outcome. Many conditions that once required open surgery can now be treated minimally invasively, but the right approach is always individualized.