So far, in 23 years, I have treated more than eight thousand patients in Serbia and abroad with a minimum percentage of mortality and complications that are below 0,5%. The youngest patient with an aneurysm was 4 years old and the oldest was 90 years old, Dr. Slobodan Ćulafić, a specialist in interventional neuroradiology, said in an interview with "Vijesti".
What exactly is interventional neuroradiology?
Interventional neuroradiology is a field that deals with vascular diseases of the blood vessels of the brain, neck and spinal cord in a minimally invasive way (intracranial aneurysm, arteriovenous malformations, narrowing of the blood vessels of the brain and neck, stroke, dissections (split blood vessels of the head and neck). The most common diseases that are treated with this procedure are brain aneurysms and acute strokes.
What are aneurysms and how is their existence manifested?
Aneurysms are sac-shaped expansions of the blood vessels of the brain, which in 95% of cases are congenital and are usually symptomless. Sometimes they can cause double images, drooping of the eyelid or problems with swallowing, depending on where they are localized.
The average number of patients we treated on an annual basis was constantly growing, from the "Sveti Sava" Hospital, where we treated 500 patients per year, to 700 patients in a year and two months at the Center for Vascular Diseases of the Brain in Dedinje. All passed without any complications, we had no deaths
When bursts occur, they are manifested by a sudden severe headache and various forms of consciousness disorders as a result of bleeding in the brain.
It is a very urgent condition where half of the patients do not survive if no intervention is done.
What causes a stroke?
In a stroke, a thrombus closes a blood vessel and leads to the sudden loss of half of the body and loss of speech. Sometimes the narrowing of blood vessels leads to a stroke. Here, endovascular intervention must be done within the first six hours in the case of anterior circulation or within nine hours in the case of posterior circulation.
How to intervene in such situations?
All these interventions are done through the groin artery or through the artery of the arm, where the catheter and microcatheter systems reach through the blood vessels of the neck, brain or spinal cord to the desired blood vessel where there is an aneurysm, which is closed with coils or stents, if there is a thrombus, it is removed with a stent or aspirates to ensure flow through the blood vessel and prevent the consequences of a stroke, if it is an AV malformation, it is closed with a special adhesive.
What makes this complicated procedure specific and why do you perform it on awake patients?
I worked on the first 1000 patients under general anesthesia, and since 2009 I have worked on almost all patients awake, except for patients who have an acute stroke or bleeding in the brain, so they cannot be calm during the intervention. I was the first to start working on patients in an awake state and I managed to introduce it as a standard in KC Tuzla, Kragujevac and Skopje.
Aneurysms are sac-shaped expansions of the blood vessels of the brain, which in 95% of cases are congenital and are usually symptomless. Sometimes they can cause double images, drooping of the eyelid or problems with swallowing, depending on where they are localized
The advantage of working in an awake state is that patients can be controlled neurologically, the procedure itself takes less time, and patients' recovery is faster. On average, these interventions last about 40 minutes, and the average stay of patients when it comes to cold aneurysms in the hospital, in the center where I worked, is two days. After that, patients are capable of normal life activities and virtually no recovery is required.
The average number of patients we treated on an annual basis was constantly growing, from the "Sveti Sava" hospital, where we treated 500 patients per year, to 700 patients in a year and two months, which we treated at the Center for Vascular Diseases of the Brain in Dedinje. All passed without any complications, we had no deaths.
Then you move to KBC Dedinje, where you form the Center for Interventional Neuroradiology.
This Center was formed with all the accompanying structure, a new angiosala and material was acquired to complete the treatment of all blood vessels at the Dedinje Institute, from head to toe, which was a great benefit for patients.
As part of the Center itself, there were two intensive care units, a reception clinic and an angio room where interventional neuroradiological procedures were performed. As part of that department, 18 medical workers were employed, of which three interventional neuroradiologists, two anesthesiologists, two neurologists plus two consultants - professors of neurosurgery and one professor of neurology.
The number of patients we treated on an annual basis represents 65-70% of all patients treated in Serbia using this method.
A part of the patients were from abroad and there was no need to send our people anywhere outside the country because we were a reference center.
The Center for Vascular Diseases of the Brain in Dedinje received a certificate and thus became a center for the education of doctors for Europe and Africa.
It was quite a surprise for everyone when this Center was closed. Why did this happen?
After everything I have done in 23 years in this field and after so many patients, education of colleagues and work in other centers and countries, during which we returned 60 patients from the operational program in one month, the Dedinje Center was closed by an unreasonable and personal decision of the Minister of Health .
You were born in Montenegro, and worked in Podgorica for some time. How do you assess the situation in Montenegrin health care, especially in the field you work in?
According to my knowledge, these procedures are performed occasionally in KBC Podgorica, and colleagues from Belgrade and earlier from Kragujevac do it, and some patients are referred to UCC Serbia.
It is best to form and educate young staff for these interventions, although it is a long process. After specialization, it takes at least 6-7 years to form a good interventional neuroradiologist, provided that he is talented, loves these interventions and is ready for the risk and stress that these interventions entail.
Impressive work resume
Dr. Slobodan Ćulafić was born in Berane, where he completed primary and secondary school.
He graduated from the Faculty of Medicine in Belgrade. After that, in 1988, he started working at the DZ in Podgorica. After three years, he went to Peć and specialized in urology there. He returned to Podgorica in 1993, and after completing a course in aviation medicine in Batajnica, he began working at the Military Airport in Golubovci as a doctor for military pilots. After two years, he received a specialization in radiology at the Academy of Medical Sciences, where he worked until 2012. He was a radiologist at the Institute of Radiology of the VMA in the beginning, then the head of the Department of Neuroradiology and for three years the head of radiology of the Institute of Radiology of the VMA as the youngest head in the history of the Institute and a lieutenant colonel at that time.
He left the VMA in 2012 and moved to the "Sveti Sava" hospital, where he formed the department for interventional neuroradiology, where he was the head until 2021, when he formed the Center for Vascular Diseases of the Brain at the IKVB "Dedinje", of which he was the manager.
Professional training in the field of interventional neuroradiology or, as they say in the USA, endovascular surgery, began in 2003 in Chicago, at Rush University, then in 2006 in Paris, at Hospital Lariboisere (department of neuroradiology), and then in Houston and New York.
As a consultant, he worked at the University of Tuzla, KC Niš, KC Kragujevac, KC Novi Sad, the University of Sofia and the University of Skopje, as well as in Adža Badem, where he is still a consultant.
He educated numerous doctors from the country and abroad, including colleagues from Kragujevac, three neurosurgeons from Sofia, two neurosurgeons and an interventional radiologist from Skopje, doctors from Sarajevo, Tuzla and Pristina.
As a pioneer, Dr. Ćulafić introduced all these procedures to Serbia and the region.
He performed the first aneurysm in 2004, arteriovenous malformation in 2007, basilar artery stenosis in 2006, stroke treatment in 2008 while working at the VMA.
The treatment of acute stroke was introduced in 2014 at the "Sveti Sava" Hospital with new stents and aspiration catheters, one year before the procedure was officially introduced into the protocol in the world.
Bonus video:
