Interventional radiology is enabling quicker surgery and recovery time for many of today’s medical complications. Dr Manish Taneja, neurointerventional specialist and vascular and interventional radiologist with Asia Brain Spine and Nerve Medical Centre in Mt Alvernia Medical Centre tells us more about this minimally-invasive procedure.
- What is stroke / aneurysm and what causes it?
Stroke is caused by loss of function of a part of the brain. This can be due to blockage of blood vessels supplying a part of the brain, or bleeding in the brain.
A brain aneurysm is a bulge, swelling or ballooning of a blood vessel in the brain. The bulge can grow over a period of time and burst, causing a stroke. Most often this bulging grows to a few millimetres before it bursts.
Brain aneurysms are common. It is estimated that 1 in 100 individuals in a given population have a brain aneurysm. The exact cause is not always known. We know that brain aneurysms run in some families. It is also common in smokers and individuals with poorly controlled blood pressure.
- What are the symptoms i.e. when to seek medical help?
Most times, individuals do not know that they have an aneurysm in the brain and the first time they find out is when it bursts and causes a stroke.
Some people do get headaches related to aneurysms. Sufferers will usually complain of very bad headaches just before the aneurysm bursts. Occasionally they might have less common symptoms like double vision or balance issues.
An MRI scan is the best way to detect a brain aneurysm especially for individuals with no symptoms.
- What are the treatments?
There are two ways to treat a brain aneurysm:
a. The traditional approach is to have an open surgery. This is where the skull bone is removed and the aneurysm is directly accessed. The neck of the aneurysm is then blocked off with a metal clip. Most aneurysms are deep-seated and this approach can be complex.
b. The latest preferred approach is minimally invasive using endovascular surgery or interventional radiology techniques.
Endovascular surgery involves making a small incision on the body to access the blood vessels. Interventional radiology is a specialty which combines endovascular surgery with the use of imaging equipment such as ultrasound, CT scan or X-ray, for example, to treat the aneurysm.
Cost is dependent on the type of aneurysm and equipment required, which can vary for each patient.
- Interventional radiology (IR) features endovascular surgery. How is it different from regular surgery?
Endovascular surgery is far less invasive, with faster recovery times. I can treat an unruptured brain aneurysm and send the patient home the next day — something not possible with regular surgery.
Also, a majority of endovascular procedures are carried out in a cardiac catheterisation lab rather than in the operating theatre. A cardiac catheterisation lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualise the arteries and chambers of the heart and treat any abnormality found.
- What conditions and issues require such surgery?
Stroke and related neurovascular diseases, peripheral vascular disease, venous disease including varicose veins, cancer and pain. And when targeting complex locations such as the brain, endovascular surgery is far safer and significantly less invasive.
The trend worldwide is to seek an endovascular approach first. Minimally-invasive surgery is available for treating diseases affecting virtually any system or organ in the body.
- Describe the recovery process, and how long it takes.
Recovery is fast with minimal scarring. Most patients go home on the same day or within one to two days after treatment. Surgery is done under sedation most of the time with fast and smooth recovery.
- Interventional radiology is said to be one of the fastest growing fields in medicine, with rapid and radical advances coming up on a regular basis. How do you see demand for it growing over the next few years?
Particularly in the last eight to 10 years, numerous new techniques and procedures have been introduced on a regular basis. When I assisted in my first brain aneurysm coiling in 1999, it took almost eight hours. Today, the same aneurysm can be fixed in under 90 minutes with a less than a one per cent risk of stroke.
I see tremendous growth coming over the next few years in neurointerventional treatments for stroke and other vascular conditions affecting the brain and the spine. Other growth areas include newer endovascular treatments for vascular and venous disease, cancer treatments, lifestyle-related interventions and interventional pain therapies.
- Describe the job satisfaction you enjoy…
I feel extremely fortunate to be one of Singapore’s full-time independent interventional radiologists in private practice. I have a really exciting and fulfilling job, and each day brings a different gratifying experience!
One day I could be treating a brain aneurysm, or removing a clot in the brain for a patient with acute stroke. Another day, I’d be doing an angioplasty, stenting of an artery in the leg or treating a varicose vein. And the next day may involve treating a liver tumour.
- How can readers reduce the risk of getting stroke or aneurysms?
Unfortunately, there is no medication or intervention to prevent brain aneurysms. The good news is that we can work on preventing stroke or aneurysm complications like bleeding. This includes controlling your blood pressure, cholesterol and blood sugar levels if you have diabetes and quitting smoking. Healthy habits like eating a balanced diet with adequate portions of fruit and vegetables, maintaining an active lifestyle with regular exercises, exercising weight control and limiting alcohol consumption go a long way in preventing stroke.