Cerebrovascular neurosurgery: priority of development
Over the past year the MC Erebouni performs an intensive work on the development of a specialized center for the treatment of strokes. This work is conducted with the direct participation and support of specialists in this area, mainly from Canada and the United States. Currently, both worldwide and in the MC Erebouni is running a program of intensive development of endovascular neurosurgery and increase of its role in the prevention and treatment of strokes.
More than a year the endovascular neurosurgery intervention is successfully performed at the MC Erebouni. It should be noted that this area of medicine is a relatively young and started to develop during last 10-15 years. In early June 2015 the Service of Cerebrovascular Neurosurgery was established at the MC Erebouni. The head of the Service was appointed neurosurgeon David Sahakyan.
In early July 2015 Head of the Service of cerebrovascular neurosurgery D. Sahakian and a leading specialist of Atlanta Medical Center and Grady Memorial Hospital (Atlanta, USA), Dr. Mikael Grigorian had jointly perform 6 cases of intervention two of which were unique and had been performed the first time in Armenia at MC Erebouni. The one intervention was case of spinal angiography that is an invasive high-precision diagnostic procedure and another is carotid artery stenting which is the endovascular surgery case.
One of the intervention was carried out in the patient G.A. 1958 y/b, with a suspected spinal arteriovenous malformation or fistula of lumbar spinal cord. In this study, MRI of the spine had show abnormal blood vessels and in conjunction with clinical data was suspected vascular malformation. Diagnostic spinal angiography allowed to examine in detail the vessels feeding the spinal cord with the accuracy and eliminate the presence of any of vascular lesions. This couldn't be achieved by other diagnostic methods.
The second case is stenting of carotid artery in patient G. 1957 y/b. He admitted to the hospital with acute ischemic stroke in the right hemisphere of the brain. According to MR and CT angiography patient has a critical stenosis (99%) at the bifurcation of the internal carotid artery. Atherosclerotic narrowing of the artery resulting in the formation of thrombus and so-called arterio-arterial embolism of the right middle cerebral artery. Due to intervention on emergency base, it was possible significantly to reduce the extent of brain damage and the severity of neurological symptoms. Subsequent CT angiography of cerebral vessels revealed restoration of patency of the middle cerebral artery.
In order to prevent subsequent ischemic attack the endovascular angioplasty and stenting of the right carotid artery was conducted. The intervention has been performed under local anesthesia and its took about an hour. The next day the patient was on his feet, and was discharged on the second day in a satisfactory condition.
Stenting of the carotid arteries is a good alternative to open carotid endarterectomy in their atherosclerotic lesions and stenosis. The advantage of the method is that there is no need for general anesthesia, incision of tissue of the vessel's wall, and therefore is less traumatic and allows rapid recovery after procedure (patient may be discharged on the second day after the intervention).
Recent studies had show that carotid stenting is as effective as carotid endarterectomy which is more traumatic.
The Directorate of MC Erebouni, as well as the Cerebrovascular Neurosurgery Service would like to thank Dr. Mikael Grigorian for his support and contribution to the development of endovascular neurosurgery in Armenia and in our Center in particular.
In turn, Dr. Grigoryan expressed his gratitude to the Directorate of MC Erebouni on its own behalf for providing the conditions for further development of specialized stroke treatment in Armenia.