Our neuroendovascular team is foundational to the transformative multidisciplinary care happening on a hospital-wide level at University of Utah Health. “Our skills and expertise in endovascular techniques enable us to completely transform the ways we typically intervened in patients with cerebrovascular diseases and, in many cases, sunset the use of traditional techniques in favor of minimally invasive, endovascular
treatments,” said Ramesh Grandhi, MD, Chief of the Neuroendovascular Division. “This is the future of neurosurgery.” With the team involved in a plethora of projects, we wanted to highlight some of the recent ones we’re most excited about.
One of Dr. Grandhi’s primary focuses is research: “We are approaching neurological diseases with a novel perspective. The concept of using the blood vessels to treat headaches, chronic subdural hematomas, cerebrospinal fluid-venous fistulas, idiopathic intracranial hypertension (IIH), and even to implant electrodes in patients with neurodegenerative diseases represents a paradigm shift, a new frontier,” Dr. Grandhi said. Through collaboration with clinicians and investigators in other departments, and thanks to groundbreaking research, the team is driving innovations that improve outcomes for patients with life-threatening conditions.
Through participation in trials like TESLA and RESCUE-ICAS, both published last year, Dr. Grandhi and his colleagues have made advances in thrombectomy for stroke care. The TESLA trial showed that patients with large core infarcts treated with thrombectomy had better results than those treated medically at the 1-year time point. The results of the RESCUE-ICAS trial were similarly promising: patients who received a stent in addition to thrombectomy had better blood flow restoration and were more likely to be functioning without assistance after 90 days. These results have changed the fundamental management of patients with large vessel occlusion strokes.
Through their participation in the EMBOLISE, MEMBRANE, and STEM clinical trials, our traumatic brain injury and endovascular teams collaborated to better understand how to best serve patients with chronic subdural hematoma, a type of brain bleed that typically requires surgery. These studies have shown that middle meningeal artery embolization, a procedure that uses an embolic agent to block
blood flow to the area, can improve patient outcomes, either alongside surgery or as a standalone procedure.
“We’re also working on vascular solutions for other conditions like IIH.” Dr. Grandhi said. Patients with IIH experience increased pressure in the skull with no real explanation. “In the past, we’ve intervened using shunts when IIH begins to cause damage to the optic nerves as a result of increased pressure, but because shunts have a high failure rate, we’ve begun treating these patients using the endovascular technique of venous sinus stenting.” To ensure best possible patient outcomes, the team is collaborating with leaders in a variety of specialties, including neuro-ophthalmology, headache neurology, and bariatric medicine, to create a team-based approach. This level of collaboration allows the team to strategize together about the best methods for each patient, optimizing care and making failure less likely.
Dr. Grandhi is joined by the rest of the neuroendovascular team, including Robert Rennert, MD, who was recently spotlighted by University of Utah Health for his collaboration with other specialties in a patient’s stroke case. After a series of transient ischemic attacks, or “mini-strokes,” Tracy Zappala was referred to Dr. Rennert, who specializes in direct arterial bypass, a surgery that involves moving an artery from one part of the brain and
connecting it elsewhere to increase blood flow and decrease the likelihood that the patient will experience future strokes. This procedure is rarely done at other hospitals but is the next frontier, according to Dr. Rennert, who is looking forward to working with other patients who will benefit from this type of specialized care.
We recently highlighted another member of our neuroendovascular team, Craig Kilburg, MD, a vascular neurosurgeon who is leading innovation in the pediatric program in close collaboration with pediatric neurologists. Not only is the team treating one of the highest volumes of pediatric thrombectomy in the country, but they are also quickly making
progress in other subspecialties, including the development of a new method of delivering intra-arterial chemotherapy for children with retinoblastoma. Dr. Kilburg, alongside collaborators, has refined a method for accessing the ophthalmic artery that was previously only used as a rescue technique, allowing them to administer the chemotherapy more effectively and efficiently.
The incredible efforts of the neuroendovascular team are not limited geographically. Another of our recently highlighted surgeons, Karol Budohoski, MD, is currently working to increase access to neuroendovascular care—specifically stroke care—in Tanzania. Alongside his team, Dr. Budohoski is developing a formalized curriculum to train neurointerventionalists in Tanzania. Outside of Tanzania, Dr. Budohoski is also leading the Global Stroke Outcomes
study, an international prospective observational study of the management and outcomes in acute ischemic strokes caused by large-vessel occlusion that will help to reduce the global burden of stroke.
“Every day, we’re working to provide transformative care that gives our patients better results,” Dr. Grandhi said. “The future of endovascular is bright, and the accomplishments of this team reflect the rapid progress and collaborative spirit of the field. I am thrilled about the prospect of looking beyond conditions traditionally considered to be cerebrovascular. Instead, we’re thinking about other neurological diseases and trying to figure out how we can help patients through an endovascular lens.”