BALLOONS IN THE BRAIN: Southeast's First Intracranial Angioplasty using Stents Performed at Emory for Stroke Prevention

A 65-year-old school teacher this week became the first patient in the Southeast and one of the first in the country to undergo intracranial angioplasty with stents.

The procedure is an advanced stroke treatment, performed by neuroradiologists, intended to prevent debilitating stroke in high risk patients. The Emory University Hospital patient had experienced several transient ischemic attacks (TIAs or "mini strokes"), associated with clogging of arteries in the brain.

Just as balloon angioplasty can "open up" occluded coronary arteries surrounding the heart that put persons at risk for heart attack, so intracranial angioplasty can open up blocked intracranial arteries in the brain to prevent cerebral thrombosis ­ one of the most common types of stroke.

Gregory Joseph, M.D., assistant professor of radiology and neurosurgery (division of neuroradiology), and Jacques Dion, M.D., director of interventional neuroradiology and professor of radiology and neurosurgery, performed the minimally invasive surgery.

The Emory team is one of the few in the country with experience performing intracranial angioplasty, a procedure still considered rare. About 20 patients have undergone the procedure at Emory University Hospital in the past few years.

This week however, was the first time the Emory team implanted a tiny, metal stent in the artery to keep it "propped open" after angioplasty.

"Blood vessels don't always stay open following simple balloon angioplasty so we needed the stent to keep it open," Dr. Joseph says.

Doctors began the procedure by pinpointing the site of occlusion within the brain's vasculature using catheterization of the brain's blood vessels. With the patient under mild sedation, a tiny balloon was inserted into the basilar artery and threaded to the site of occlusion, using X-ray for guidance. Once at the specified site, doctors "inflated" the balloon, compressing the plaque and opening up the vessel. Because the vessel would not stay open, the team then placed a small stainless steel mesh coil at the site of blockage. The stent will eventually become part of -- and will fortify ­ the vessel wall.

The patient has had no recurrence of stroke symptoms since undergoing the 90-minute procedure.

Percutaneous coronary transluminal angioplasty was pioneered in the late 70s by Emory physician-scientist Andreas Gruentzig, M.D., and the first coronary stent implantation in the United States was performed in 1987 by Spencer B. King III, M.D., director of interventional cardiology at the Emory University School of Medicine and president of the American College of Cardiology.

The interventional neuroradiology team at Emory University Hospital has been involved in similar breakthroughs in treating acute stroke in the last five years. Interventional neuroradiology is a component of Emory Heart & Vascular Center.