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Treatment Options

Maine Medical Center offers the most advanced neuroendovascular techniques for treating cerebrovascular disease and disorders, enabling us to tailor the most appropriate treatment to each patient’s unique needs:

  • Acute ischemic stroke
    • A medication called tPA (short for tissue plasminogen activator) currently is the only thrombolytic (clot-busting) drug approved by the FDA for treating acute ischemic strokes. Intravenous (IV) administration of tPA is often a first-line treatment for strokes caused by blood clots; however, it doesn’t work for all patients and the window for treatment is generally only three hours from the onset of stroke symptoms. Fortunately, through the neurointerventional techniques available at Maine Medical Center, appropriate stroke patients have several other treatment options that expand the window for treatment as well:
      • Intra-arterial tPA – The clot-busting drug is delivered via catheter directly to the area of the blockage. This approach expands the window for treatment to as much as six hours after onset of stroke symptoms.
      • MERCI Retriever – The MERCI (Mechanical Embolus Removal in Cerebral ischemia) Retriever, as its name indicates, is used to mechanically remove blood clots from the brain. A tiny corkscrew-like device is delivered via catheter from the femoral artery (in the groin) to the site of the blockage in the brain. The MERCI Retriever ensnares the clot and then is withdrawn from the body, restoring blood flow to the brain. This treatment can be used up to eight hours after the onset of stroke symptoms
      • Penumbra Stroke System – The Penumbra system uses suction to remove a blood clot, quickly restoring blood flow in the brain and limiting the damage caused by a stroke. The Penumbra also is delivered to the brain using a catheter inserted through a small incision in the groin. Using x-ray guidance, the device is carefully maneuvered through the body’s blood vessels to the site of the clot in the brain. A separator is advanced and retracted through the catheter to dislodge the clot, and a suction device grabs the clot to remove it from the body. This approach can also be used within eight hours of symptom onset.

Maine Medical Center’s neuroendovascular specialists currently treat an average of two ischemic stroke patients per week – a number that is growing as more people learn to recognize the symptoms of stroke, understand the importance of seeking prompt medical attention and are aware of the extensive treatment resources available close to home. 

  • Arteriovenous malformation (AVM)
    Arteriovenous malformations (AVMs) are abnormal collections of immature blood vessels within the brain which can cause seizures or hemorrhage, causing stroke. An AVM can be treated with surgery or radiosurgery (radiation) depending upon its location and size. 
    • AVM embolization – Before either therapy, embolization is often performed to reduce the size and vascularity of the AVM, which helps to make surgery or radiosurgery more effective. Like endovascular coiling of an aneurysm, AVM embolization is a non-surgical, minimally invasive procedure that involves the threading of a microcatheter or tube through a blood vessel in the groin, which is then navigated to blood vessels in the brain. Once there, a special glue called ONYX, particles, metal coils and/or alcohol are inserted into the AVM to block blood flow, which causes the AVM to shrink.
  • Narrowed or blocked carotid and vertebral arteries
    The carotid and vertebral arteries pass through the neck to supply blood to brain, brainstem and upper spinal cord. The two carotid arteries are located in the front of the neck on either side of the throat. The vertebral arteries are located in back of the neck and are mostly contained within the cervical spine. These arteries may become narrowed (stenosed) or completely blocked from atherosclerosis, a disease in which fatty deposits, called plaque, collect on the inside of the blood vessels. As atherosclerosis progresses, it may reduce blood flow to the brain. Pieces of plaque may also break off and lodge in smaller blood vessels downstream, resulting in a stroke, or transient ischemic attack (TIA).
    • Carotid or vertebral artery angioplasty – In carotid or vertebral artery angioplasty, the neuroradiologist uses a microcatheter to reopen the narrowing of the carotid artery(s) or vertebral artery. Once the catheter reaches the site of the narrowing, a miniature balloon is inflated to reopen the artery. The interventionist also may insert a stent – a tiny mesh scaffold – to help prop the artery open.
  • Intracranial (within the skull) arterial blockages
    Blockages in the intracranial arteries located between the brain and its middle membrane are particularly dangerous because they can rupture easily.
    • Intracranial angioplasty and stenting – Intracranial angioplasty and stenting is used to reopen blockages in intracranial arteries. Similar to carotid angioplasty, the neuroradiologist threads a microcatheter into a blocked artery to reopen it, usually with a tiny balloon, and may also use the catheter to place a tiny meshwork stent in the reopened artery to help keep it open.