Thomas W Link, MD, MS

06/23/2021

Difficult wide necked right MCA bifurcation aneurysm. The challenge with these is to occlude the aneurysm without compromising the normal MCA branches that are involved in the neck of the aneurysm. An intrasaccular WEB device was deployed within the aneurysm and a FRED Jr flow diverting stent was placed across the neck. At 6 month follow up angiogram (bottom right), the aneurysm was gone and all normal branches were filling normally.

06/03/2021

Pushing the boundaries of endovascular technique at Northwell. This high risk dural arteriovenous fistula, illustrated in the first set of images, would traditionally require open surgical disconnection. A scepter mini balloon microcatheter was navigated distally in the right ophthalmic artery adjacent to the fistulous connection, well past the central retinal artery and the supply to the eye, shown in the second set of images. Onyx liquid embolic was injected until there was good pe*******on into the vein. The third set of images shows the Onyx cast and complete cure of the fistula, with preservation of the proximal ophthalmic artery and choroidal blush of the eye. This patient went home the next day with intact vision.

04/27/2021

Middle meningeal artery (MMA) embolization is gaining traction as a minimally invasive alternative or adjunct to surgical evacuation of chronic subdural hematoma (SDH). Here are 3 ways it is useful with 3 illustrative case examples:

1. Upfront treatment in high risk surgical patient: patient with diffuse large B cell lymphoma on chemotherapy with thrombocytopenia (platelets as low as 40k), small R SDH initially managed conservatively (A), progressed over time with worsening headaches (B), underwent R MMA embolization, 3 month MRI shows complete resolution (C).

2. Recurrence: elderly patient with large (2.7cm) L chronic SDH s/p crani for evacuation, returned with recurrence s/p second evacuation, postop scan with small residual (D), returns again with mild word finding difficulty and recurrence 1.9cm (E), underwent L MMA embolization, 3 month CT shows complete resolution (F).

3. Postop “prophylaxis”: elderly high risk patient with 3cm mixed density SDH (G) underwent burr hole evacuation, moderate residual postop (H), underwent L MMA embolization, 3 month CT shows near complete resolution (I).

04/04/2021

Beautiful result for this 1cm basilar tip aneurysm. The basilar artery runs along the brainstem, and is difficult and treacherous to approach surgically. Traditionally, this aneurysm would have required a major, high risk brain surgery. This case was done with only a puncture of the radial artery in the wrist, with catheters brought up into the head and into the aneurysm. A single WEB device was deployed and 6 months later, the aneurysm is cured.

03/29/2021

Proud to offer the cutting edge in neuroendovascular technology at Northshore University Hospital

A promising neuroendovascular treatment option is now helping neurosurgeons safely reach complex brain aneurysms with a single device deployed through a much smaller catheter, allowing for better control of bleeding, […]

11/09/2020

Beautiful view from the office

09/21/2020

Proud to be a part of this training program! I think the best part is at 54 seconds..

Northwell Health is New York State’s largest health care provider and private employer, with 23 hospitals, nearly 800 outpatient facilities and more than 14,...

09/02/2020

The utility of intracranial stenting for atherosclerotic disease remains controversial, but sometimes it is the only option. Example - small cerebellar infarct, found to have occlusion of the left vertebral artery, stenosis of the V4 segment of the right vert (image 1), and stenosis of the right vert origin (2). While therapeutic on Aspirin and Plavix, had a second stroke involving cerebellum (3), midbrain (4) and thalamus (5). Resolute Onyx balloon expandable stent placed across both (6, 7). Continuing to recover one month out, no further strokes.