Cerebrovascular & Comprehensive Stroke Center: Conditions Treated, Services & Programs

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CONDITIONS TREATED AND SERVICES OFFERED

Cerebrovascular disease includes all disorders affecting the blood vessels (i.e., arteries and veins) of the brain, head and neck and spinal cord. At our Stony Brook Cerebrovascular and Comprehensive Stroke Center, we offer diagnostic services and treatments for the full range of cerebrovascular disease.

Listen as our co-director, neurointerventionalist, David Fiorella, MD, PhD, explains to WLIW's Gianna Volpe, on her "Medical Monday" show, how new, minimally invasive techniques and programs at Stony Brook Cerebrovascular and Comprehensive Stroke Center are reducing deaths and disabilities caused by stroke across Long Island.
(May 9, 2022 — Starting point: 17:55; End: 34:09)

Our services and treatments include:

Our multidisciplinary expert team offers both in person and telemedicine consultations for the treatment of all cerebrovascular disease processes. Contact us for a consultation: Cerebrovascular Neurosurgery: (631) 444-1213. Endovascular Neurosurgery: (631) 444-1213. Vascular Neurology (Stroke Neurology): (631) 444-2599
 

Diagnostic Cerebral Angiography: We perform over 1000 angiographic procedures every year at Stony Brook Medicine. Our high experience level allows us to perform these procedures safely and efficiently. We currently perform nearly all of our diagnostic angiography procedures using a transradial approach (through the wrist artery). This is a safer and easier approach than traditional transfemoral approach which is still used at many insitutions providing this procedure. Our transradial approach has been supported by extensive data which have demonstrated that transradial angiography results in lower risks of access site bleeding shorter length of hospital stays, shorter periods of bed rest and greater patient comfort and satisfaction.


Brain Aneurysms (Cerebral Aneurysms): A brain aneurysm occurs when the wall of an artery supplying blood flow to the brain bulges out to form a balloon-like structure. Arteries carry high-pressure blood flow from the heart to the organs of the body. The constant pressure within an artery can cause brain aneurysms to grow over time and eventually leak (or rupture). When a brain aneurysm leaks, this causes arterial force bleeding to occur and enter into the fluid space around the outside of the brain. This type of life-threatening bleeding is called a subarachnoid hemorrhage – which is a common type of hemorrhagic stroke.

Stony Brook Medicine has long been a leader in complex brain aneurysm treatment. As a result, clinical trial sponsors seek us out as a trial site, often making Stony Brook the first on Long Island or in the country to offer brain aneurysm treatment options not available elsewhere. Led by David Fiorella, MD, PhD, our brain aneurysm treatment team will work with you to determine the best plan for your particular brain aneurysm. If your aneurysm requires treatment, it is our goal to accomplish this easily and safely in a way that causes minimal disruption of your normal daily life.  

  • Minimally Invasive Brain Aneurysm Treatments: Stony Brook Medicine has pioneered many of the most important minimally invasive treatments for brain aneurysms. Most all brain aneurysms requiring treatment can be treated at Stony Brook using minimally invasive endovascular techniques. We specialize in the treatment of complex brain aneurysms using technologies such as:

Learn More

New Clinical Trials and Devices Expand Treatment Options for Wide-Neck Bifurcation Aneurysm

We are currently participating in multiple ongoing clinical research trials for brain aneurysm treatment that allow us to offer our patients the newest and most advanced brain aneurysm therapies.   

  • Brain aneurysm clipping: Our cerebrovascular specialists perform open brain surgery and place a tiny metal clip at the base of your aneurysm to cut off its blood supply.

Vascular malformations: High-flow vascular malformations occur when there is an abnormal connection or “short circuit” between the arteries and veins of the brain or spinal cord. This “short circuit” allows the rapid flow of high pressure arterial blood flow directly into the venous structures, which are not structured to accommodate high flows and high pressures. This creates a potential for the malformation to rupture (bleed). The “short circuit” can also cause high venous pressures, which can result in brain swelling (i.e., brain edema) leading to seizures, headaches and/or stroke-like symptoms. Most people who have a vascular malformation of the brain or spinal cord are born with them, but they can occasionally form later in life. The two of the types of high-flow vascular malformations involving the brain and spinal cord are dural arteriovenous fistulae (dAVF) and arteriovenous malformations (AVMs).

  • Arteriovenous Fistula (AVF): An abnormal connection between arteries supplying the coverings of the brain and/or spinal cord and the veins. These malformations are usually acquired later in life, although they can occasionally occur in children. At Stony Brook Medicine, most all of these types of malformations can be cured through minimally invasive procedures performed through the inside of the blood vessels with minimal recovery time.    
  • Arteriovenous Malformation (AVM): An abnormal connection or entanglement between arteries supplying the brain and/or spinal cord and veins. AVMs are congenital, meaning that patients have these malformations from birth. While present from the time of birth, patients often times do not become symptomatic until adulthood. Headaches, seizures, and sometimes brain bleeds can be the first presenting symptoms of brain AVMs. At Stony Brook Medicine, brain AVMs can sometimes be cured altogether through minimally invasive procedures performed through the inside of the blood vessels. open surgery or radiosurgery. Other times, we treat these malformations using a combination of a minimally invasive (embolization) procedure, open surgery or radio surgery.

Stroke: There are two general categories of stroke – ischemic and hemorrhagic. Stony Brook Medicine has experts in the treatment and diagnosis of both kinds of stroke.

  • Ischemic stroke: An ischemic stroke occurs when an artery that supplies blood flow to the brain becomes blocked or severely narrowed (or “stenotic”). Blockage of a brain artery can result from a blood clot traveling from someplace else in the circulatory system (“a thromboembolus or embolus”). It can also result from plaque build up in the brain artery itself (i.e., “hardening of the arteries” or “intracranial atherosclerotic disease”), which causes a narrowing of the artery.
  • Hemorrhagic stroke: Refers to any condition resulting in bleeding within or around the brain. Bleeding within the brain can be caused by high blood pressure (a hypertensive hemorrhage), blood-thinning medications, from underlying disease in the brain’s small blood vessels (e.g., amyloid angiopathy) and from brain aneurysms and vascular malformations (e.g., AVMs, cavernous malformations).

Transient Ischemic Attack (TIA): Often referred to as a “mini stroke,” TIA is a brief episode (sometimes lasting just a few minutes) during which a region of the brain does not receive enough blood flow to function normally. Because the blood supply is restored quickly, the affected brain tissue does not die as it does in a stroke. The most common TIA symptoms include (but are not limited to) difficulty speaking or understanding speech, loss of feeling on one side of the body or face, or weakness on one side of the body or face. These attacks are often early warning signs of an impending major stroke. If you have experienced any of these symptoms it is important to seek medical attention and undergo appropriate evaluation and testing.


Carotid Stenosis: “Carotid stenosis” is caused by the build-up of fatty plaque (atherosclerosis) within the walls of the carotid arteries that causes them to become severely narrowed (i.e., “stenotic”) The carotid arteries are the major arteries that carry blood flow to the front portion of the brain (i.e., the “anterior circulation”). Carotid stenosis can cause a TIA and/or an ischemic stroke if the narrowing becomes severe enough to limit blood flow to the brian or if pieces of the atherosclerotic plaque break off and float up into the brain and block off brain blood vessels. Carotid stenosis may be present for a long time before symptoms of TIA or ischemic stroke first appear. People with severe atherosclerotic disease affecting other areas, for example the coronary arteries, screening for carotid disease may be needed. Carotid stenosis can be diagnosed by a carotid ultrasound – a simple test that does not require a dye injection or radiation. Stony Brook Medicine has experts in the diagnosis and treatment of carotid stenosis (link). Available treatments for carotis stenosis include:

  • Carotid Angioplasty and Stenting (CAS): A minimally invasive procedure that improves the blood flow through carotid arteries that are blocked by plaque. This image-guided procedure involves the widening (i.e., dilation) of the narrowing with a balloon catheter (thin plastic tube) followed by placement of a stent (a self-expanding metal tube) that holds the blood vessel open. We are currently participating in multiple research trials of carotid stenting, which provide our patients access to the newest technologies for the treatment of carotid disease.
  • Carotid Endarterectomy (CEA): An open surgical procedure during which the carotid artery can be opened up and the plaque causing the blockage can be directly removed.

We have  several ongoing clinical trials, which provide our patients access to some of the newest, best and safest technologies for treatment of carotid stenosis.


Intracranial Atherosclerotic Disease (ICAD) or Intracranial StenosisICAD refers to narrowing of an artery inside of the brain caused by atherosclerosis (also known as “hardening of the arteries”). This can also lead to TIA or ischemic stroke. While ICAD is most often treated with aggressive medical therapy (blood thinners, blood pressure medications and cholesterol medications), it does sometimes required treatment with intracranial angioplasty and stenting. Stony Brook Medicine has particular expertise in the medical and interventional management of ICAD, as Dr. Fiorella was a National Co-Principal Investigator for the pivotal Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS), which defined the standard of care for the treatment of this disease.


Emergent Large Vesssel Occlusion (ELVO): ELVO is an acute occlusion of a major artery supplying the brain causing the immediate onset of stroke symptoms. The occlusion must be removed immediately to restore blood flow to the brian to prevent ongoing, irreversible brain damage. When a brain artery is occluded, minutes matter, and the saying is “Time is Brain.” These patients are taken immediately to the angiography suite for a procedure known as a “mechanical thrombectomy,” where the arterial blockage is cleared and blood flow to the brain is restored. If blood flow is restored early after symptoms first appear, patients can often make a fast and immediate recovery from these stroke symptoms. We perform over 150 thrombectomy procedures per year at Stony Brook and the number continues to increase every year. We are also participating in multiple ongoing thrombectomy clinical trials.


Mobile Stroke Unit Program: In 2019, David Fiorella, MD, PhD, led efforts to bring to Stony Brook Medicine, what is still Long Island's only program of its kind. Serving over 40 different communities, and working in collaboration with over 40 emergency medical service (EMS) agencies throughout Suffolk County, the mobile stroke unit team provides specialized, life-saving care to people within the critical moments of stroke, before they even get to the hospital. This markedly accelerates the time required to make  an accurate stroke diagnosis, allows for time-sensitive stroke therapies to be administered early, and allows for the transport of stroke patients directly to the most appropriate hospital for the level of care they require, the first time.


Chronic Subdural Hematoma (cSDH): Chronic subdural hematoma refers to a fluid collection which accumulates over the surface of the brain. These collections put pressure on the brain and can cause many different symptoms which can include headache and head pressure, confusion, cognitive decline, seizures, weakness, numbness and difficulty with speech. In the past the treatment of these collections required open surgery.

  • Middle Meningeal Artery (MMA) Embolization: At Stony Brook Medicine, we have pioneered this new minimally invasive procedure, which in some cases allows us to cure many of these collections without open brain surgery. During this procedure we can block off the arteries supplying the coverings of the brain with a glue-like substance. We access these arteries with our small catheters that are often inserted through the artery of the wrist (radial arteries) and guided up into the head. The procedure often times can be performed with a same day admission or a brief overnight stay. The MMA embolization procedure can also be performed before or after brain surgery for cSDH. MMA embolization may reduce the risk for reaccumulation of blood after surgery or in some cases can be effective to treat residual blood collections after surgery.

Brain Tumor: Many brain tumors are very vascular making surgical remove difficult and dangerous.

  • Tumor embolization: This minimally invasive procedure involves having a small, thin tube (catheter) guided into the feeding arteries of a tumor to either shut down the blood supply to the tumor or to deliver therapy directly to the tumor to destroy it.

Cushing’s Disease: Refers to an endocrine disorder where too much cortisol is produced by the body. It is sometimes difficult for physicians to determine what organ is responsible for the elevated cortisol levels.

  • Inferior Petrosal Sinus Sampling (IPSS): an invasive procedure in which hormone levels are sampled from the veins that drain the pituitary gland to determine whether a pituitary tumor is responsible for Cushing's disease

CONSULTATION
Our multidisciplinary expert team offers both in person and telemedicine consultations for the treatment of all cerebrovascular disease processes. Contact us for a consultation:

Cerebrovascular Neurosurgery:  (631) 444-1213
Endovascular Neurosurgery: (631) 444-1213
Vascular Neurology (Stroke Neurology): (631) 444-2599