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This procedure seems almost miraculous. Instead of opening the skull to treat neurological problems, surgeons instead puncture a blood vessel in the leg, arm, or neck to gain access to the body's system of arteries and veins. Then, using a tube called a catheter, the surgeon navigates to the problem area by viewing radiology images on a high-resolution screen. 

Along with the advantage of having a tiny surgical incision, patients who undergo endovascular surgery generally have a shorter recovery time and fewer post-surgical complications. Yale Medicine’s multidisciplinary approach enables us to customize care for each patient using cutting-edge techniques and equipment.

What conditions can be treated with endovascular surgery?

Major conditions treated with endovascular surgery are brain and spinal cord aneurysms, tangled blood vessels in the brain and spine known as vascular abnormalities, and fistulas (abnormal connections between arteries and veins), which also occur in the brain and spinal cord.

Endovascular surgery is also used to treat carotid stenosis, a narrowing of the carotid arteries in the neck, and to clear blood clots in the brain when treating stroke.

What are the advantages of endovascular surgery?

Endovascular surgery involves a small puncture wound at the skin. The procedure is often less time-consuming than traditional “open” vascular access surgery, in which a surgeon makes a larger incision in the head or torso to access the abnormal blood vessels. Endovascular surgery can be safely performed under conscious sedation, rather than a general anesthetic.

Recovery time is generally shorter and there's also less of a chance of post-surgical complications compared with traditional surgical techniques.

Endovascular surgery isn't appropriate in every situation. Patients must be individually evaluated to determine the best course of treatment.

What makes Yale Medicine’s approach to endovascular surgery unique?

Yale Medicine’s multidisciplinary approach enables us to customize care for each patient using cutting-edge techniques and equipment.

Magnetic resonance imaging (MRI) can be performed during surgery, in order to target treatments and ensure their safety and effectiveness. (At most hospitals, physicians will need to move a patient to a different location in order to perform an MRI.)

Along with high-resolution MRI scans available during surgery, the hybrid neurovascular room also allows neurosurgeons to perform the surgery using state-of-the-art imaging technology, which provides a detailed, close-up view of tiny blood vessels from two angles or in three dimensions. 

Murat Gunel, MD, co-director of Yale's Neurogenetics program and director of Neurovascular Surgery, says his team's knowledge and expertise can help our surgeons better monitor and treat patients who may be at especially high risk of conditions such as brain aneurysm.