Webinar Stroke Has No Age Limit: Dr. Martinez neurointerventional radiologist

Dr. Mesha Martinez, a neurointerventional radiologist, presented her practice’s approach to treating brain and spinal conditions through minimally invasive procedures and consultations. She shared detailed case studies and explained her work on CSF drainage issues, venous stenosis, and the use of various medications for treating AVMs and related conditions. The discussion covered the complexities of venous treatments, the experimental nature of certain medications, and the importance of understanding underlying venous pathologies in brain health, with a focus on the role of the venous system in neurointerventional radiology. You can watch the Webinar here

Mesha presented an overview of her company and research, focusing on various inhibitors like tramatinib and Avastin, explaining their mechanisms and uses. She shared her clinic’s approach to treating patients with AVMs and mentioned a specific case she would discuss in more detail. Raylene expressed interest in the scientific aspects and praised Mesha’s presentation. They confirmed the meeting was being recorded and prepared to let attendees in at 7 PM.

Dr. Mesha Martinez introduced her practice, Clarity Brain and Spine, which provides specialized neurointerventional care. She explained that her practice currently operates on a consultation-only basis, with fees for telehealth consultations, and she is in the process of seeking insurance recognition. Mesha clarified that while she cannot write prescriptions or perform procedures, she can provide expert advice and recommendations for next steps, with the possibility of collaboration with referring physicians.

Mesha, a radiologist by training, explained her role as a neurointerventional radiologist, highlighting her expertise in diagnosing and treating conditions of the head, neck, brain, and spine using minimally invasive procedures. She described her background in interpreting various imaging modalities and her ability to collaborate with neurosurgeons and neurologists. Mesha emphasized her role in complex cases where other specialists may be stumped, and she detailed the procedures she performs, including angiograms, pain injections, and treatments for cerebrospinal fluid leaks.

Mesha presented a case study of a 16-year-old patient with unexplained neurological symptoms, initially misdiagnosed as an aneurysm and later found to have a CSF leak. After performing a myelogram, Mesha identified the leak and treated it with a blood patch, which provided temporary relief. Further investigation revealed a venous drainage issue, highlighting the importance of examining both arteries and veins in vascular brain disorders.

Mesha discussed her work on CSF drainage issues and venous stenosis, highlighting a case where a stent successfully treated a patient’s symptoms. She explained that high pressure and leaking are interconnected processes that can lead to various symptoms often misdiagnosed as psychiatric issues. Raylene praised Mesha’s focus on the venous system in neurointerventional radiology, which is less common in the United States. Mesha elaborated on the importance of the venous system in brain health, explaining how vein-related issues can cause AVM ruptures, seizures, and other symptoms. She noted that some European colleagues are increasingly focusing on the venous system in brain health, a perspective that is starting to gain traction in the U.S.

Mesha and Raylene discussed the occurrence of venous fistulas after AVM removal, a phenomenon they had observed in some community members. Mesha explained that when veins clot off, they can attract arterial inflow to reopen, potentially leading to abnormal connections between arteries and veins, as seen in dural AV fistulas and vein of Galen malformations. They explored the possibility that these conditions might be triggered by underlying venous pathologies or genetic factors like MEC and KRAS mutations, with Mesha expressing interest in further research to understand these complex mechanisms.

Mesha and Raylene discussed the complexities of treating arteriovenous malformations (AVMs) and fistulas, particularly focusing on the challenges and limitations of venous treatments. Mesha explained that while arterial embolization is well-established and safer due to consistent arterial anatomy, venous treatments are newer and riskier because of the unpredictable nature of venous anatomy and the potential for vein rupture. She noted that venous treatments are not currently recommended for children due to these risks and the need for specialized expertise, though they may become more common in the future.

Mesha explained the use of three types of drugs to treat brain vessel diseases, including CRAS inhibitors, MEK inhibitors, and Avastin, which are being investigated for patients with AVMs that are difficult to treat with traditional methods. She noted that these medications are not FDA-approved for AVMs but are being used in specific scenarios where surgery, radiation, or embolization are not viable options. Mesha emphasized that these treatments are still experimental and not suitable for all patients, as they require certain genetic markers and are primarily considered for aggressive or symptomatic AVMs.

Dr. Martinez discussed the use of Avastin and other medications for treating AVMs and related conditions, explaining that some treatments are approved for specific syndromes while others are available through compassionate use or clinical trials. She clarified that while liquid biopsies for AVMs are being investigated, they are not yet standard practice due to safety concerns and limited data. Raylene mentioned her son’s successful treatment with Avastin after radiation-induced swelling, and Dr. Martinez elaborated on how Avastin can help manage edema caused by AVMs. The discussion concluded with information about the International Pediatric Stroke Organization (IPSO), which aims to raise awareness, advance education, and support research for pediatric stroke and related conditions.