Stroke - TIA - Aneurysm

Holy Cross Hospital recently implemented the use of the newest, most state-of-the-art imaging technology available in South Florida for stroke treatments today. Enabling physicians to capture and view detailed three-dimensional images of the brain vasculature through the use of an innovative angiographic X-ray lab.

Through the acquisition of this technology, Holy Cross Hospital and Laszlo Miskolczi, MD, are now able to conduct minimally invasive procedures to treat a wide range of clinical problems including stroke, carotid artery disease, brain aneurysms and other vascular disorders. These catheter-based procedures present fewer risks, require no haircut, leave minimal scarring and require shorter recovery times than those involved with traditional surgical approaches.  The new technology and the presence of a dedicated stroke team enables Holy Cross Hospital to become a comprehensive stroke center and will help physicians to minimize or "undo" the consequences of an acute stroke if patients arrive in time.

Tissue Plasminogen Activator/ Intracranial Tissue Plasminogen Activator

Tissue plasminogen activator (t-PA) can be used to treat some people who are having a stroke caused by a blood clot (ischemic strokes). It is given in a vein (intravenously, or IV) at the hospital and in some cases may be given directly into an artery. The medicine must be given within a very short time period immediately  after stroke symptoms begin. Therefore it is important to call 911 and get to help immediately upon recognizing symptoms. Strict criteria must be met in order to use the medicine. The medicine can be used to prevent disability after a stroke.

Every minute in acute ischemic stroke, it is estimated that 1.9 million brain cells die. Our team works fast to determine the type of stroke(ischemic or hemorrhagic), tPA dissolves blood clots, and would not be given  to someone who has a bleeding stroke. Studies have shown that tPA has helped people with strokes caused by clots (ischemic strokes). The sooner tPA is given after stroke symptoms begin, the better the outcome for the patient. tPA can help treat a stroke, thus saving brain cells, so it is important for those who have the sudden onset of stroke symptoms to call 9-1-1 immediately.  

Thrombectomy Procedures

When life-threatening blood clots obstruct the arteries of your brain (known as a intracerebral infarction or “brain attack”), a catheter-directed thrombectomy may be required. A thrombectomy is simply the removal of a thrombus, or clot, from a blood vessel, performed to restore circulation.

Some of the possible benefits of having a catheter-directed thrombectomy include:

  • Rapid restoration of blood flow
  • Removal of thrombus from the body
  • Quick resolution of symptoms
  • Potential for eliminating or reducing amount and duration of medications


Aneurysm Clipping

The goal of surgical clipping is to isolate an aneurysm from the normal circulation without blocking off any small perforating arteries nearby. Under general anesthesia, an opening is made in the skull, called a craniotomy. The brain is gently retracted to locate the aneurysm. A small clip is placed across the base, or neck, of the aneurysm to block the normal blood flow from entering. The clip works like a tiny coil-spring clothespin, in which the blades of the clip remain tightly closed until pressure is applied to open the blades. Clips are made of titanium and remain on the artery permanently.

Aneurysm Coiling

Endovascular therapy is a minimally invasive procedure that accesses the treatment area from within the blood vessel. In the case of aneurysms, this treatment is called coil embolization, or "coiling.”  In contrast to surgery, endovascular coiling does not require open surgery. Instead, physicians use real-time X-ray technology, called fluoroscopic imaging, to visualize the patient's vascular system and treat the disease from inside the blood vessel.

New Pipeline Procedure for Large Aneurysm

An aneurysm is a weak, enlarged area in an artery (blood vessel). Over time, the force of normal blood pressure can cause it to rupture, which can be life-threatening and cause significant disability in survivors. The American Association of Neurological Surgeons estimates that every year 30,000 people in the United States experience a ruptured brain aneurysm. Aneurysms are more prevalent in people ages 50 to 60 and three times more prevalent in women. 
The Pipeline Embolization Device (PED) is a flexible mesh tube made of platinum and nickel-cobalt chromium alloy that can be used to block off large, giant, or wide-necked aneurysms in the internal carotid artery, a major blood vessel supplying blood to the front of the brain. The device can also reduce the likelihood that an aneurysm will rupture.


Carotid endarterectomy is a type of surgery used to remove plaque from the carotid artery. It is the third most common kind of cardiovascular surgery in the United States. During the operation, the surgeon peels the plaque away from the carotid artery. Once the plaque is removed from the carotid artery, more oxygen-rich blood can flow through the artery to the brain. This reduces the risk of stroke.

Carotid and Intracranial Stents

Blood vessels inside the brain are prone to narrowing or hardening. Called "intracranial atherosclerosis," about 70,000 people in the U.S. each year have an ischemic stroke caused by narrowed arteries. In most cases intracranial atherosclerosis is discovered during diagnosis when a patient has a stroke, or a mini-stroke or TIA (transient ischemic attack). The risk of having a second stroke increases almost 10 times after the first stroke. Recommended treatments for intracranial atherosclerosis usually include exercise, healthy diet and weight loss together with anti-platelet and cholesterol-lowering medications. In certain cases, the narrowing can be treated with the help of angioplasty and stent placement.
Intracranial angioplasty and stent placement is performed under general anesthesia, with close monitoring of the heart rate and blood pressure. The small plastic tube is passed through the artery in the leg (femoral artery). Through the catheter, first an angioplasty balloon is passed and the lesion is opened up so that the stent can be easily tracked and positioned across the narrowing. The stent pushes the plaque against the walls of the blood vessel, providing unrestricted blood flow to the brain. After the procedure the patient is monitored in the ICU, and then followed closely after discharge.