Name of the Procedure:

Endovascular Intracranial Prolonged Administration of Pharmacologic Agent(s) (Arterial)

Summary

This procedure involves the prolonged delivery of medication directly into the arteries within the brain, using a catheter. It includes the placement of the catheter, diagnostic angiography to visualize blood vessels, and imaging guidance to ensure accurate delivery of the medication.

Purpose

The procedure targets conditions within the brain that require direct and sustained administration of medication. The goal is to deliver a high concentration of a drug precisely to the area of need, enhancing therapeutic effectiveness while minimizing systemic side effects.

Indications

• Cerebral vasospasm
• Blood vessel conditions that are not amenable to treatment through systemic medication
• Situations where other methods of drug delivery have failed or are not possible

Preparation

• Fasting for several hours before the procedure.
• Adjustments to medications as advised by the healthcare provider.
• Pre-procedure diagnostic tests, such as blood work and MRI or CT scans, to assess the condition and plan the treatment.

Procedure Description

1. Under anesthesia or sedation, a catheter is inserted into a large artery, usually in the groin or arm.
2. The catheter is navigated through the blood vessels to the targeted area in the brain using imaging guidance.
3. Diagnostic angiography is performed to obtain detailed images of the vascular system.
4. The pharmacologic agent is administered directly into the affected vascular territory.
5. Imaging guidance ensures the drug is delivered accurately and continuously over an extended period.

Duration

Typically takes a few hours, depending on the complexity of the condition and the number of vascular territories involved.

Setting

Performed in a hospital setting, usually in a specialized angiography suite or interventional radiology room.

Personnel

• Interventional radiologist or neurointerventionalist
• Nurses specialized in interventional procedures
• Anesthesiologist (if general anesthesia is used)
• Technicians to assist with imaging and equipment

Risks and Complications

• Common: Bruising or bleeding at the catheter insertion site, headache
• Rare: Stroke, infection, allergic reaction to the contrast dye or medications, vessel damage Management: Immediate medical intervention to address any complications

Benefits

• Targeted delivery of medication improves efficiency and effectiveness.
• Reduced systemic side effects compared to oral or intravenous drug administration.
• Can provide relief from symptoms and contribute to the resolution of the underlying condition.

Recovery

• Close monitoring in a recovery room or intensive care unit immediately after the procedure.
• Post-procedure imaging to assess the outcome.
• Instructions on activity restrictions and medication changes.
• Follow-up appointments to monitor recovery and response to treatment.

Alternatives

• Systemic administration of medication (oral or intravenous)
  • Pros: Non-invasive, easier administration
  • Cons: Less targeted, higher risk of systemic side effects, possibly less effective for certain conditions
• Surgical interventions for certain conditions
  • Pros: Direct access, may provide a permanent solution
  • Cons: More invasive, higher risk of complications, longer recovery time

Patient Experience

• Some discomfort and pressure during catheter insertion.
• Sedation or anesthesia minimizes pain and anxiety during the procedure.
• Possible headache or grogginess post-procedure.
• Pain management and comfort measures are provided to ensure a smooth recovery.