MIR Clinical Specialties

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Conditions we treat

Aneurysms: Aneurysms are weakend areas in blood vessel walls, common seen as bubbles that form on the wall of arteries in the brain. Aneurysms can rupture with fatal consequences, however, not all aneurysms rupture and not all aneurysms need to be treated. An aneurysm can be treated surgically or by endovascular techniques, such as through endosaccular embolization using detachable platinum coils or by placement of a flow-diverter sten in the involved arterial section. About half (130 cases annually) of all cerebral aneurysms at Barnes-Jewish Hospital are treated by endovascular techniques.

Arteriovenous Malformations (AVMs) : AVMs are abnormalities of the arteries and veins in which a direct connection, or short circuit, exists between the arteries and veins. Most are congenital, meaning that patients are born with this connection. Symptoms of headache, seizures, or bleeding do not usually appear until the 3rd or 4th decade of life. Rarely infants or small children are found to have an AVM. Surgery, radiation, and endovascular treatment are complementary techniques used for the treatment of these lesions. These abnormal vessels can be blocked with different materials injected through catheters (tubes) placed through the blood vessels into the lesion.

Carotid Cavernous Fistulas (CCFs) : CCFs are an uncommon but unique subgroup of arteriovenous malformation. Most are acquired later in life than AVMs. They can be separated into direct connections between the carotid artery and the veins of the cavernous sinus (usually due to trauma) or indirect connections in which small arterial branches supply the veins. Both types can be treated very effectively with different endovascular devices

Cerebrovascular Stenosis: Atherosclerotic disease or hardening of the arteries can cause severe narrowing (stenosis) of the arteries of the neck and brain. Sometimes these narrowings may cause a stroke (permanent damage to the brain from lack of blood supply) or temporary symptoms of a stroke. This can be from particles of blood clot or plaque breaking free from the narrowing or from a reduction in the flow through the vessel because of the narrowing. In some patients, these narrowings can be opened using balloons inside the blood vessel (case example). Sometimes we place metal tubes (called stents) to help keep the vessel open.

Strokes: Most strokes are caused by blood clots lodging in the arteries of the brain. These blood clots can come from the heart or from atherosclerotic plaque in the vessels anywhere from the heart to the brain. If the blood clot blocks the artery for long enough, the brain cells ordinarily supplied by that artery will die from lack of oxygen and nutrients. In some patients, the clot can be removed using clot-retrieval devices, such as stent retrievers or clot aspiration catheters, and/or with clot-dissolving (fibrinolytic) drugs delivered through tiny catheters to the site of the clot in the artery in the brain

Vascular Tumors: Some patients with vascular tumors of the brain or spine undergo embolization before surgery. Embolization refers to blockage of arterial supply using small particles through a small catheter (tube). The advantages of embolization is that blood loss during surgery can be reduced, making surgery safer, faster, and potentially allowing a more complete removal of the tumor.

Vasospasm: When an aneurysm ruptures, the bleeding over the surface of the brain sets in to motion a cascade of chemical events that results in severe narrowing of the arteries of the brain several days after the rupture. This narrowing may be so severe that medical treatment to keep enough flow through the vessel may fail. In these patients we can often open their arteries with direct administration of some different drugs and by using balloons to dilate the vessels.

Spinal Malformations: Arteriovenous malformations (AVMs) and vascular tumors often involve the spine or spinal cord.


We also perform a variety of non-vascular procedures in the spine. These include biopsies, nerve root injections for pain relief, and diagnostic discograms.