San Francisco VA Health Care System
Neurointerventional Radiology: Healing Veterans Nationwide
Steven Hetts, MD, is one of about 500 Neurointerventionalists in the United States. He and Daniel Cooke, MD, are Neurointerventionalists at the San Francisco VA Medical Center (SFVAMC). They treat Veterans for diseases such as brain aneurysms, brain and spine arterio-venous malformations, acute strokes, and tumors.
Have you heard about Neurointerventional Radiology? If you haven’t, you’re not alone. It is a very effective technique used to treat conditions that occur in blood vessels of the brain, head, neck, and spine. Neurointerventional procedures are minimally invasive, performed through tiny incisions. Under advanced live X-ray imaging, miniature surgical tools can be placed through long narrow tubes from the thigh to almost any part of the body, including the brain. Recovery times from these procedures are much faster than for open surgical procedures.
Dr. Hetts describes a displayed X-ray of a brain aneurysm: “Here’s what it looks like beforehand, abnormal swelling or out-patching of the blood vessel, at risk for rupturing and bleeding. This patient was dizzy, sort of spinning, so he came in, an MRI was ordered, and he was diagnosed with an aneurysm.” He points to another X-ray showing the repaired aneurysm: “We were able to go in through the blood vessels, insert a catheter all the way up into the blood vessel. We laid a stent, which creates a mesh, and we are able to put (platinum) coils into the aneurysm itself. What we’re able to do then is to fill up the aneurysm with these coils, and clot off the aneurysm, leaving the main blood vessels in the brain open.”
Results? The patient’s aneurysm was repaired and his hospital stay was only two days.
“This technology was basically first invented 20 years ago,” said Dr. Hetts. “Some aneurysms were totally untreatable before this technology came along. The previous technique was a craniotomy, which involves making a large hole in the head and putting a surgical clip on it, and you’re in the hospital typically for 5-10 days. With our procedure the hospital stay is only two days, and a patient can be back to normal activities in a week.”
SFVAMC is the only VA Medical Center to offer Neurointerventional Radiology. “Basically that’s why we have the desire and ability to accept Veterans from all over,” said Dr. Hetts. “Our Medical Center Director, Larry Carroll, has been very supportive of this, so we have received a number of patients from Rocky Mountain region, Montana, Utah, as far as Oklahoma, a patient from Georgia…even a Veteran who sometimes lives in the US but most of the time lives in Australia.”
“This is a very sub-specialized service that we offer for diseases of the blood vessels in the brain and spine. It’s a young field that started in the 1980’s to early 1990’s,” explained Dr. Hetts. “If you looked at treatment of brain aneurysms around the world 15 years ago, I’d say 95 percent of them get clipped with open surgery and 5 percent of them get coiled, or embolized through the blood vessels. And now, about 60 percent of aneurysms are treated just through the blood vessels.
SFVAMC’s Neurointerventional Radiology sees patients on Wednesdays and Thursdays, and is available to expand services. “We have the equipment and the expertise: I’m a full-time Neurointerventionalist who trained at UCSF, here since 2008. I have a partner who joined me just last year, Dr. Daniel Cooke. We’re able to cover the VA and perform these procedures at SFVAMC. Previously they were referred out. It’s a tremendous cost savings for the VA system,” said Dr. Hetts. “What’s really nice is for continuity of care. With CPRS we can access patients’ medical records from all over. Through telemedicine, we can determine what’s best for the patient.”
What training is required for this subspecialty? Dr. Hetts explains: “We have a lot of practice. The great thing about having trained at UCSF is, a two-year neurointerventional fellowship which came after a year of neuroradiology, four years of diagnostic radiology, and a one year internship, so at the end of that it was eight years…and I did over 800 cases during my fellowship alone. So you come out very experienced.”
“We’ve had essentially 100% treatment success rate in terms of fixing aneurysms that are of the right shape and size to fix through the blood vessels. Not only do the Veterans benefit from the treatment, they also benefit from much more advanced diagnostic MRI scans, and the research that goes along with that,” said Dr. Hetts. Some of that research has involved ongoing clinical trials of new devices, including cutting-edge intracranial stents. Other NIH-sponsored research is ongoing to develop new kinds of catheters that can be remote-controlled inside of patient’s bodies under MRI guidance, as opposed to X-ray guidance. Patients benefit from no X-ray radiation, and also better navigation.
“We’re the first VA that offers the full suite of neurointerventional treatment, said Dr. Hetts. “We’re very happy to bring this service to the VA.”