Treatment of Acute Stroke
Interventional neuroradiologists are an integral part of the stroke team at Hoag Hospital. As part of the Code 20 initiative, patients suspected of having an acute stroke are rapidly triaged through the Emergency Room so they can undergo an emergent CT scan (see Advanced Neuroimaging for further detail). Immediately after the scan is performed, the radiologist discusses the results with the patient's neurologist and ER physician. Depending on the circumstances of the patient's condition, he or she may be a candidate for thrombolysis which is the administration of clot-dissolving medication which can be injected into a peripheral vein, usually in the arm (intravenous) or into an artery via a catheter which is advanced from the groin into the brain (intraarterial). Intraarterial thrombectomy has also become a popular treatment option by our Interventionalists. We commonly extract intraarterial clot with a suction catheter. Intraarterial thrombolysis and thrombectomy are highly specialized procedures performed by an Interventional radiologist. Many new and exciting advances in endovascular treatment of stroke are coming our way. The Hoag NeuroInterventionalists remain poised to introduce these new innovations as they become available.
Treatment of Cerebral Aneurysms and Vascular Malformations
Cerebral aneurysms are abnormal balloon-like outpouchings of blood vessels within the brain. Depending on their location, size, and patient risk factors, they are at risk of rupturing and causing intracranial hemorrhage. These aneurysms can often be treated non-invasively using endovascular embolization performed by a highly specialized Interventional neuroradiologist. Similar to a conventional angiogram, a catheter will be inserted into the femoral artery in the groin and positioned within the brain. Through the catheter, metallic coils and possibly a stent will be placed within the aneurysm to prevent blood from entering it.
Endovascular embolization can also be performed in some patients with vascular malformations (specifically arteriovenous malformations, or AVMs) using metallic coils and/or glue.
When you schedule your appointment, we will inform you about any specific preparations depending upon the specific procedure your doctor has ordered. Please contact the Scheduling Department at 949.764-5573 if you have any questions.
Beginning several days before the procedure, you will need to discontinue certain medications.
- If you are taking Plavix, Coumadin, Warfarin or Pradaxa, must stop 5-7 days prior to your procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
- If you are taking Aspirin, Naprosyn, Ecotrin, Ibuprofen, Advil, Motrin, Aleve, Naproxen or Celebrex on a regular basis, we ask you to stop 5-7 days before your exam procedure but you MUST check with prescribing physician first before stopping to see if you doctor has an alternative medication or instructions for you.
- If you take Lovenox, you must stop 12 hours before your procedure.
- Stop taking fish oil, flax seed oil, vitamin E, 5 days prior to your procedure.
- Tylenol or acetaminophen are not an issue if you are currently taking them.
This procedure requires radiographic contrast:
- You should inform your physician if you have any allergies. If you have been told you are allergic to contrast or have ever had a reaction to Iodine or any form of contrast media, your doctor may prescribe medications to reduce the risk of an allergic reaction. A Radiology nurse should contact you. If you have not been contacted by a Radiology nurse at least 24 hours prior to your appointment, please contact the Imaging Scheduler immediately.
- If you have diabetes, kidney problems, lupus, surgery on your kidneys or multiple myeloma, you must have lab work that includes a BUN and Creatinine performed within 30 days of your exam. If you are over the age of 65 you must have lab work within 90 days of your exam. This provides us with information regarding your current kidney function. Please call your physician if you have not had this blood work.
- If you have been diagnosed with diabetes and/or you are currently taking any of the following medications: Metformin, Gluicophage, Glucophage XR, Fortamet, Riomet, Metaglip, Glucovance, Actoplus Met, Avandament or Junamet, stop taking your medication for a total of 48 hours after your exam. You must contact your physician for alternative medications and instructions prior to your exam
- If you are currently receiving Dialysis; please schedule your dialysis to follow your procedure with Contrast or the following day. It is imperative you have dialysis no later than the following day after you have received contrast for your procedure.
- We encourage you to hydrate with oral fluids at least 24 hours prior to your study. You may have only clear liquids as well as your necessary medications 2 hours before your exam.
Please complete, print out and bring with you the following forms to your appointment:
Outpatient Medication Reconciliation form (for Breast Center and Interventional Procedures)
- Download PDF
Locations where NHRA provides Interventional Neuroradiology services