Minimally invasive aneurysm or stroke treatments often mean surgeons reach the brain via a groin artery. Some now take a new route through the wrist.

Story by: Joe Hall on May 1, 2019

When most people think of aneurysm or stroke treatments, they imagine brain surgeons cutting into the skull. But in reality, surgeons usually stop these dangerous clots and bleeds by passing tiny tools through the femoral artery in the groin all the way up to the damaged area of the brain.

But now doctors at Norton Neuroscience Institute are using a new approach. Instead of going through the groin, Mahan Ghiassi, M.D., and Mayshan Ghiassi, M.D., brothers and endovascular neurosurgeons with Norton Neuroscience Institute, are accessing the brain through the patient’s wrist.

“Heart physicians have used this wrist, or radial, approach for years,” said Dr. Mayshan Ghiassi. “The artery in the wrist connects to the brain, which also makes this a viable option for stroke and aneurysm treatment.”

The surgeons with Norton Neuroscience Institute are among only a handful in the country using the radial approach, which takes its name from its use of the radial artery in the forearm.

“It’s a more complex procedure that requires more expertise,” Dr. Mayshan Ghiassi said. “But the benefits are worth it.”

Faster recovery without general anesthesia

The wrist approach can allow for a quicker recovery from stroke or aneurysm. With the radial approach — unlike going through the groin — patients aren’t put under anesthesia. This alone makes the procedure safer.

Even though the patient is awake, the procedure is painless. Drs. Ghiassi even use a special injector so the patient doesn’t feel the needle prick into the wrist.

Another benefit is that patients can get up and move around right after the procedure. With the groin approach, patients must remain on their backs for several hours after treatment.

“There’s also less pain during recovery, and no scarring,” said Dr. Mayshan Ghiassi. “Patients love it.”

Patient drives across the state to get radial treatment

Tina Terrell had an aneurysm rupture in 2012. The massage therapist from Paducah, Kentucky, first sought treatment in Tennessee, where doctors used the groin approach. When she needed additional treatment last year, doctors referred her to Norton Neuroscience Institute.

“I was told the expertise and service at Norton rivaled the best hospitals around,” Tina said. “And they were right.”

Tina needed a special stent that allowed the body to eliminate the aneurysm. Typically, placing the stent required invasive, and risky, brain surgery. She met with Drs. Ghiassi, who recommended the radial approach. She’s glad they did.

“I went home the day after the procedure and was back at work several days after that,” she said. “The recovery was great. As a massage therapist I use my wrists a lot, and the procedure didn’t slow me down. I’m feeling great and was so pleased with the compassionate care I received from everyone.”

‘The future of treatment’

Drs. Ghiassi are using the treatment for both emergency and nonemergency strokes and aneurysms. Right now, they’re doing the radial approach on about half their patients, but Dr. Mayshan Ghiassi expects that number to grow.

“Unless they’ve had a previous surgery on the arm, radial artery surgery, or are just too anxious to hold still, going through the wrist is likely an option,” he said. “We think this is the future of treatment.”