Stroke and Cerebrovascular Disorders
Our neurosurgeons have expertise in the diagnosis, treatment and care of patients with a wide range of cerebrovascular disorders. Rhode Island Hospital is the only hospital in the state, and one of only a few in the region, to offer advanced therapies such as aneurysm coiling, embolization for vascular malformations, and intracranial angioplasty and stenting. We work with neurologists and neuroradiologists in a multidisciplinary approach to care for patients who have suffered stroke or cerebral hemorrhage. The interventional neuroradiology service at Rhode Island Hospital offers treatment for a broad range of cerebrovascular diseases, including aneurysms, vascular malformations and ischemic stroke, using minimally invasive techniques combined with high-end imaging technology.
Rhode Island Hospital offers the full range of cerebrovascular services, including traditional surgery, minimally-invasive endovascular surgery, non-invasive radiosurgery and state-of-the-art critical care in a dedicated neuro-intensive care unit. State-of-the-art 3D neuroimaging provides a powerful means of accurately diagnosing and understanding an individual’s vascular disease. Because of the wide array of services available, each individual patient has customized care tailored to his or her particular situation. Our sub-specialized physicians are trained in the management of these diseases, and know whether and when one should intervene, and what type of treatment is likely to be most effective and most safe for a specific patient.
Conditions We Treat
Aneurysms are abnormal enlargements of a portion of an artery, often forming an out-pouching or pocket off the side of the vessel from which it originates. Aneurysms are more common in women, and may grow over many months or many years. They are more common in those with atherosclerosis and smokers, though in rare cases they may be genetic. Aneurysms may be discovered incidentally on an MRI or CT of the brain (that is, unexpectedly found when the scan was obtained to look for something else), or they may be discovered, unfortunately, when they rupture. Rupture of an aneurysm can be a life-threatening event.
Caring for someone with a ruptured aneurysm requires rapid assessment of the situation by highly-trained emergency physicians and neurosurgeons, as well as a critical care team trained in the management of the many serious consequences of that event, ranging from recognizing and treating blood vessel spasm to treating the cardiac effects of brain aneurysm rupture. Definitively treating the aneurysm itself requires subspecialty physicians and surgeons working together to decide which approach is best.
Unruptured aneurysms have risks for bleeding that depend upon many factors, including where the aneurysm is located in the brain and how big it is. Weighing these risks against a patient’s overall medical condition and particular preferences requires a careful dialogue with a team of physicians capable of providing the full range of therapeutic options and dedicated to providing the best, individualized care.
Carotid stenosis is the full or partial occlusion of the carotid artery by atherosclerotic disease. It is a serious medical condition that, unrecognized or untreated, can lead to stroke. The best management for a particular patient’s disease depends on the degree of the stenosis (occlusion) and the quality of the available medical and surgical options. Rhode Island Hospital offers the full range of treatments, including comprehensive medical care, carotid artery stenting, angioplasty and endarterectomy.
Cerebral Arteriovenous Malformations (AVMs)
Cerebral AVMs are abnormal growths of tangled arteries and veins in the brain. They can be completely asymptomatic, or they can bleed or cause seizures. Deciding if and when to treat AVMs once they are discovered requires a thoughtful consultation with cerebrovascular experts who have at their disposal the full spectrum of therapies. Treatment of AVMs is often a collaborative process involving coordinated endovascular and open procedures for occluding and resecting the AVMs “nidus.” In some cases, non-invasive radiosurgery (such as gamma knife surgery) may be an option. The cerebrovascular team at Rhode Island Hospital works seamlessly together to deliver the best and most comprehensive care for AVMs.
Cerebral Arteriovenous Fistulas (AVFs)
Cerebral AVFs are abnormal short-cuts between arteries and veins that bypass the small capillaries that normally connect them. In some cases, AVFs can rupture and cause a brain hemorrhage. When an AVF is discovered, either because of hemorrhage or based on a brain scan, whether and how to treat it become the primary concerns. Rhode Island Hospital has interventional radiologists and neurosurgeons who are proficient in the management and treatment of these vascular abnormalities, using endovascular and/or open surgical techniques, as any individual situation may require.
Spinal Vascular Malformations and Fistulas
Like cerebral AVMs, vascular malformations and fistulas in the spine are abnormal blood vessels that may impair neural function or bleed. They may be discovered incidentally on MRI, or because they are causing symptoms such as weakness, or because of a hemorrhage. Treatment may involve endovascular and/or open neurosurgical approaches, and is customized according to each patient’s specific problem. Rhode Island Hospital neurosurgeons and interventional radiologists have the expert judgment to know which approaches are likely to work best, and the technical skill to carry out the necessary procedures safely and effectively.
Cavernous Angiomas of the Brain and Spine
Cavernous angiomas, also known as “cavernomas,” are abnormal expansions of small blood vessels. Because the blood vessels are so small, catastrophic hemorrhage is not generally a concern. However, small amounts of bleeding over time can put pressure on nearby brain cells and pathways so that neurologic function can be impaired, and sometimes seizures can result (if the cavernoma is near certain parts of the brain). Definitive treatment of cavernomas consists of operative resection, although non-invasive radiosurgery might be an option in some cases. Our neurosurgeons are specialists in both types of treatment, and work with patients to determine the safest and most certain treatment for cavernous angiomas.
Moya Moya Disease
Moya Moya Disease is a condition in which important blood vessels in the brain become gradually occluded over time. This disease is usually hereditary, but its specific cause remains unknown. This disease is usually discovered during childhood, though adults (more typically women) may develop the disease as well. As the vessels become narrower, patients may have strokes due to blockage of blood flow or hemorrhages. Determining the best treatment for a particular patient with Moya Moya Disease requires careful consideration of several potential surgical options by a cerebrovascular team comfortable with the full range of procedures. Rhode Island Hospital neurosurgeons and interventional radiologists are experts in the diagnosis and management of this condition.
The Stroke Center at Rhode Island Hospital provides services to more than 900 adult and geriatric patients with suspected transient ischemic attack (TIA) or stroke annually. As the region’s only primary stroke center located within a Level 1 trauma center, Rhode Island Hospital is uniquely qualified to provide the most advanced clinical care to acute stroke patients.