Interventional Stroke Rounds – Stroke Prevention with Wingspan Stent

Interventional Stroke Rounds – Stroke Prevention with Wingspan Stent

I am Dr. Coleman Martin a neurointerventional
specialist at the Saint Luke’s Brain and Stroke Institute in Kansas City, Missouri. This is Interventional Stroke Rounds. Today, we have a man in his early seventies
who recently had a minor stroke in the back part of his brain, called the cerebellum.
This temporarily affected his balance and coordination. The cause of his stroke was
investigated with an MRA scan. He was found to have a blockage of his vertebral artery.
He was treated with medication but, unfortunately, stroke symptoms returned. Urgently, I performed an angiogram entering
his arterial system at the right groin. A catheter was advanced up the aorta up to the
left subclavian artery and then in to the left vertebral artery. From here we can take
pictures of the blockage. Here we see 3-dimentional pictures of our
patient’s head. As we rotate the picture to see the back of the head we begin to see the
blockage of the left vertebral artery. I will render the bones translucent so we can see
more clearly. This blockage is quite severe. While most
of us have two vertebral arteries supplying the brain stem he has only one vertebral artery.
A blockage at this location can lead to a severe, even fatal stroke. Through the catheter I am injecting contrast
and under X-ray we are seeing the blood flowing in the left vertebral artery. Repeating the
injection we can see the blockage marked by the red arrow. I placed a wire across the blockage. Now, over the wire, I am advancing a tiny
balloon up to the blockage. To see the balloon it has two tiny black markers that show up
under X-ray. They allow me to place the balloon in the center of the blockage. This is a Gateway angioplasty balloon designed
to relieve blockages of brain arteries. I will inflate it with some blue dye so you
can see how it works. Back to our patient, I am double checking
the position of the balloon. Notice how slowly the blood is flowing. The tiny balloon is
nearly enough to occlude the blockage. I gently inflate the balloon to stretch the
artery. Taking another picture the blockage is better
but not good enough to place a stent. Using a larger balloon, I am stretching the
artery a bit more. Taking another picture balloon has nearly
stretched the artery back to normal size. Now are ready to deliver a Wingspan stent
across the blockage. This will prevent the artery from collapsing back to its previous
state. I am releasing the Wingspan stent across the
blockage. Under X-ray we can see tiny black dots opening as the stent is released
across the blockage. One end of the stent is open. In just a moment, there, the other
end is open. Let us look at a Wingspan stent outside the
body. Here, I will open one in my hand. Do you see how it unfolds and would conform to
the inside of an artery? It is made of an alloy called nitinol. It is strong enough
to hold an artery open yet still flexible enough to pass through the curvy blood vessels
leading to the brain. Magnified under X-ray, we again see the stent
opening inside the artery. Time to take another picture. The flow is
much better, but the artery still isn’t quite perfect. I will bring up a slightly large balloon and
center it on the residual blockage. I inflate the balloon stretching the artery to its full
size. Looks good. That artery is flowing normally, once again. At Saint Luke’s hospital we have a wealth
of experience in using stents in the brain. While stents can not prevent every stroke,
when one is needed, day or night, we are ready. I hope you found Interventional Stroke Rounds
interesting. At Saint Luke’s hospital we care about stroke and interventional education.
Feel free to share this video on your blog, Facebook and Twitter. Another stroke, got to go.

2 thoughts on “Interventional Stroke Rounds – Stroke Prevention with Wingspan Stent

  1. Thank you for creating and uploading this very informative video. I am a student of Medical Imaging from Australia. This has been very valuable to aid my study.

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