How do we define interventional neurology?
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Dr Shakir Hussain
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It is a relatively new subspecialty, as the name suggests it pertains to the interventional aspects in neurology. These are vascular interventions, done inside the vessels, however they can be done outside the vessels also. Globally and the most commonly it is synonymous with vascular intervention. Because majority of our interventions are stroke, our department is called interventional neurology and stroke. We do not deal with other interventions, such as pain management.
What is the stroke burden globally and in India?
Out of every 10 patients coming to a hospital, four to five patients on an average might be stroke patients, however that is variable, depending on practice patterns. It would not be a true reflection of what an ideal number would be. Upto 100,000 new stroke patients are added every year in America. However, if were to extrapolate the burden of stroke would be 10 times in a country like India. A look at any hospital’s neurology casualty services, would reveal that 70 to 80 per cent of the cases would be amounting to stroke.
Could those with cardiovascular diseases be susceptible to neurological conditions?
Many heart patients have artherosclerosis in heart arteries and none in brain arteries and vice versa. Roughly 50 to 60 per cent patients would have an overlap, the rest (40 per cent would have an isolated disease in one organ only). Particularly in the young population, isolated brain involvement is more common. The nature of disease is unknown. This is more common in Asian population. In the West, such incidence is 10 per cent, but in South Asian population it varies from 40 to 50 per cent.
How has the advancement in radiology helped neurosciences?
Brain imaging systems use an X-ray based mechanism to visualise the brain. Initially, they were primitive since they did not have many applications for finer analysis of the vasculature. It is a huge leap to the instruments of today, in tune with the needs of the physicians. When we ‘re doing an intervention, it’s a blind procedure, to make it relatively semi blind, we need some pathway to see, else we were using our own visual imagination of the anatomy of vessels, which is very complex. These equipment offer us a roadmap, so when we inject a contrast, it would hold that image on the screen and it would convert it into a negative image. Subsequently when we take a positive image, it would superimpose over the negative image. It will show the path of the vessels on the screen, an evolution which happened 10 years ago. New applications such as 3D rotational angiography, wherein we create volume rendering, develop mathematical algorithms, give us precise measurements of the vessels and arteries for precise deployment of devices within the body. The end goal is patient safety.
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