CHANDIGARH,06.11.20-The Department of Radioadiagnosis at PGIMER will soon have the latest state-of-the-art Biplane Digital Subtraction Neuroangiography (DSA) suite for providing improved services for a variety of neurovascular disorders stated Prof. M.S.Sandhu, Head, Deptt. of Radiodiagnosis and Imaging. This will be the first of its kind advanced catheter laboratory in this part of the country. Currently, the neurointervention section of the department caters to a large number of patients suffering from various neurological disorders like cerebral aneurysms, carotid artery disease, arteriovenous malformations, acute ischemic stroke and a variety of vascular disorders related to brain, spine and head and neck. This addition would enhance the diagnosis and treatment of all types of stroke and provide faster and more accurate vascular care, amongst helping in other disorders too.

Neurointervention or endovascular neurosurgery involves minimally invasive treatment of complex disorders of the brain. As the name suggests, these procedures do not involve opening of the skull and are possible with very small incisions in the groin or wrist without the need of putting any sutures. The brain is then accessed by the use of small flexible tubes called catheters and wires taken through the incision across vessels of the abdomen or arm right until the brain to perform complex Brain surgeries. This navigation and subsequent surgery is aided by high tech DSA equipment, the latest version of Azurion Biplane 20/15 NeuroSuite image guided therapy system has been procured by the department, said Prof MS Sandhu, department Chief, who is an ardent proponent of advanced technology in medicine. These catheter-based procedures are designed to reduce some of the risks and recovery time found in traditional open surgical approaches. Among the many benefits of catheter-based interventions are shorter hospital stays, reduced recovery time without the pain of a large incision, and less visible surgical scarring.

The new DSA system boasts of an ergonomic design and intuitive user interface which optimizes workflow, reduces preparation and procedure time, and provides high quality imaging, achieving tremendous visibility of the catheters and wires at low radiation dose levels. A distinct advantage of this ‘Biplane’ system (over the single plane system) is its ability to visualize the brain in two planes which improves the accuracy of treatment with markedly less complication rates as well as quicker procedure time. There is increased safety of both patients and the operating physician from the harmful X-rays that DSA uses through its low-dose imaging capabilities. “Both our patients and clinicians can benefit from the high speed, low radiation dose levels, and outstanding image quality of this new DSA system,” explained Prof MS Sandhu. “It will allow our physicians to complete a variety of diagnostic and interventional procedures much faster, and that means the patient is off the table and on their way to recovery and discharge much sooner.”

The unit will be equipped with two very advanced machines which are available at very few centres in India. The hi-tech artificial intelligence software that has been acquired with the DSA Cath lab is the “RAPID-AI” software system, which has transformed the management of acute stroke across the globe. This artificial intelligence based platform helps in the quick and accurate determination of brain injury occurring secondary to sudden cessation of blood flow to the brain in cases of brain attack. Brain stroke or brain attack occurs secondary to clot formation in the arteries of the brain which leads to sudden onset paralysis, vomiting, posture instability and even unconsciousness in these patients. The key to treat these patients is quick imaging by CT or MRI scans and re-establishment of blood flow to these areas by either giving blood thinners or removing the clot by means of stents and catheters and wires by neurointerventionalists using the DSA equipment. RAPID-AI automatically analyses the CT or MRI scan data and detects the area of the brain that is potentially salvageable. This increases the accuracy of detection as well as reduces the detection time as compared to the human eye, thereby optimizing the treatment time and recovery rates in these patients.

The treatment using DSA equipment begins with injection of iodine based contrast material inside the blood vessels which aids in the visualization of the vascular system of the body, thus serving as a roadmap and guide for navigation of catheters and wires. This injected contrast, however, may damage the kidneys in susceptible patients i.e. in whom the renal functions are already deranged like in diabetics, chronic renal disease, amongst others.

A recently developed injector with a very novel method to map these vessels is to use carbon dioxide as a contrast agent which is safe in these patients especially in Body procedures. This technique has been endorsed by various medical and surgical societies like the European society of vascular surgery which promotes it in appropriate groups of patients. Carbon dioxide has the unique properties of lack of renal and liver toxicity, good solubility (leading to quick dissolution in blood stream), good patient tolerance limits and safe lung expulsion. However, it requires very sophisticated injector devices which can deliver a constant, safe and controlled injection of the carbon dioxide gas. PGIMER has acquired this very specialised equipment which will be a boon for all patients of kidney disease, diabetes and contrast allergies, who normally suffer delay in angiographic procedures like angioplasties and stenting due to risk of iodinated contrast toxicity. This Angiodroid CO2 injector is, again, the first of its kind in the country and will help tremendously in treatment of various diseases by angiographic means in these patients, stated Prof. Sandhu.