Interventional neuroradiologist

Interventional Neuroradiology (INR) or Endovascular Surgical Neuroradiology (ESN) is an Accreditation Council for Graduate Medical Education (ACGME) and European Union of Medical Specialists (UEMS) medical subspecialty specializing in minimally invasive image-based technologies and procedures used in diagnosis and treatment of diseases of the head, neck, and spine.

Diagnostic angiography

The first experience with cerebral angiography was developed by Portuguese doctor Egas Moniz at the University of Lisbon, in order to identify central nervous system diseases such as tumors or arteriovenous malformations. He performed the first brain angiography in Lisbon in 1927 by injecting iodinated contrast medium into a carotid and using the rays discovered 30 years earlier by Roentgen to visualize the cerebral vessels. In pre-TC and pre-RM, it was the only tool to observe the structures within the skull and was also used to diagnose extravascular pathologies.

Subsequently, European radiologists further developed the angiographic technique by replacing the traumatic direct puncture with catheterization: in 1953, Swedish physician Sven Seldinger introduced the technique of arterial and venous catheterisation still in practice. In 1964, the Norwegian radiologist Per Amudsen was the first to perform a complete brain angiography with a transfemoral approach, as it is performed today; he then moved to San Francisco to teach the technique to american neuroradiologists. These two stages, at the basis of modern invasive vascular diagnostics, prepared the way for later therapeutic developments.

The first treatments: balloon occlusion

The first to carry out a true endovascular treatment was Charles Dotter, the father of the angioplasty and considered by many as the father of all interventional radiology as well as the first to have performed endovascular treatment. On January 16, 1964, he performed a therapeutic angioplasty of a superficial femoral artery in a 82-year-old woman with an ischemic leg refusing amputation. The artery remained open for the next 2 and a half years after which the woman died of pneumonia.

In the 1970s Fedor Serbinenko developed a technique for closing aneurysms with balloons that were released into the internal carotid artery by occluding the light. The first treatment was performed in 1970 in Moscow, with the occlusion of an internal carotid to treat a carotid-cavernous fistula. He can be considered, therefore, the first interventional neuroradiologist. This technique was subsequently refined by neuroradiologists all over the world: the first and most brilliant were Gerard Debrun in Canada, Grant Hieshima in San Francisco and Jacques Moret in Paris.

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Wikipedia