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“Several clinical trials have now
shown that the coiling technique
...has excellent outcomes that
are superior, in some cases, to
craniotomy for treatment of
cerebral aneurysms.”
“Several clinical trials have now shown that the
coiling technique, when used appropriately,
has excellent outcomes that are superior, in
some cases, to craniotomy for treatment of
cerebral aneurysms,” he says. The procedure
may also be used, in combination with surgical
resection and radiation, to treat arteriovenous
malformations (AVMs), which are abnormal
connections between the arteries and veins of the
brain. AVMs occur in less than 1 percent of the
U.S. population, but may cause life-threatening
intracranial bleeding in more than 50 percent of
affected patients.
More recently, endovascular techniques are
being used to treat strokes — the third leading
cause of death in the U.S. UCLA interventional
radiologists invented the first FDA-approved
medical tool, the Mechanical Embolus Removal
in Cerebral Ischemia, or MERCI device, to
remove blood clots from the brain in patients
experiencing an ischemic stroke. Until a few
years ago, it was possible to treat ischemic stroke
only with clot-busting medications that had to
be administered within a few hours from initial
onset of the event.
For Dr. Gonzalez, the next frontier is
developing surgical techniques to prevent
strokes. In a procedure called encephalo-duro-
arteriosynangiosis (EDAS) surgery, he reroutes
healthy arteries located below the ear and places
them in close proximity to narrowed arteries in
other areas of the brain. Over time, the rerouted
arteries will grow, form new connections with
nearby brain tissue and increase blood flow to
diseased areas, Dr. Gonzalez explains. To date,
he has performed the procedure in more than a
100 patients at UCLA, with good results and few
complications. He received the American Heart
Association 2012 Innovation Award in Stroke
Research for his work in this area.
Over the next 10 years, Dr. Gonzalez anticipates
that stroke research will focus on identifying
methods to expand treatment for acute stroke
patients, including methods of neuroprotection
to improve the body’s resistance to stroke, and on
advancing stem cell research in the area of brain
tissue repair. The goal is to prevent both new and
recurrent strokes. Approximately 25 percent of
people who recover from their first stroke will
have another one within five years.
“We’re happy to evaluate all patients in the
UCLA Stroke Center, even those whose risk
factors have already been treated,” Dr. Gonzalez
says. “We’re available 24-7 with a complete
spectrum of services. Every day, we make new
discoveries and our patients are an important
part of developing innovative techniques that
will save lives in the future.”
Following encephalo-duro-
arteriosynangiosis (EDAS) surgery,
an angiogram (left) shows branches
of the superficial scalp arteries
growing to provide increased
blood flow to intracranial arteries.
The growth pattern (right) of
these new vessels resembles the
tendrils of a vine.
“MERCI has improved the treatment of stroke
in two major ways,” Dr. Gonzalez explains.
“Thanks to that development, we can now open
arteries from the inside without medications
or tools that may potentially increase
complications, and we have an expanded window
of time to treat patients. Rather than having only
a few hours, we now can effectively treat stroke
patients using mechanical devices from six to
as many as 12 hours after onset of ischemic
stroke symptoms.”
1 1 UCLA Physicians Update