Kieran Murphy

When did you decide you wanted a career in medicine? Why interventional neuroradiology?

I decided to be a doctor when I was in the Boy Scouts and found that I enjoyed first aid and helping people. I chose interventional neuroradiology because I found it the most challenging thing I could do, both intellectually and emotionally.

Which technique or technology had a profound effect on your career?

It is hard to say. On the vascular side, coiling aneurysms has had a great impact, but acute stroke intervention is an incredible procedure. On the spine side relieving someone’s agonising pain with a simple vertebroplasty is very impactful.

Who has inspired you in your career and what advice of theirs do you remember today?

My parents have influenced me greatly. I was also inspired by my cousin Oliver who had an untreated hydrocephalus when I was a child in Ireland. We still do an appalling job in that disease. I was also inspired by a boy in my class who died of leukemia, and a neighbour who died of an osteosarcoma when I was a child.

Mr Grace, the registrar of the Royal College of Surgeons, who let me into medical school, Jim Brunberg ,a great radiologist and Daniel Rufenacht, a genius and artist in the neurovasculature, were all inspirations too.

What are your three favourite inventions?

My hand-held disposable ozone generator, the size of a 20cc syringe, which I designed on an eight-hour flight home from a “neuro” meeting in Bologna. The US FDA are giving us grief over it, but it is brilliant and builds on the idea of Mario Muto and the other brilliant Italian interventionalists who started doing this procedure. Airplanes are great because you get left alone for long periods of time which is essential for creative thought.

My density and drug-eluting coronary stent design which you can see at implantation but elutes density over time allowing visualisation of the lumen on CT without beam hardening artifact is another invention I am proud of.

The use of parathyroid hormone systemically in pulsed doses to integrate bone cement. This delivers like fertiliser in a garden, as a spray using a vibrating needle, not a weight-bearing cement injection. We have to move on from focusing on the implant which is so industry-driven. The future is about biomiomicry, doing things and leaving no footprint.

Cardiology know that while they may stent a vessel, the plavix and lipitor and angiotensin-converting enzyme are the critical long-term elements, not the stent. We have to get to this point.

As a keen inventor, what have been your proudest moments?

When you invent something, it takes 5–7 years for it to become accepted. All the time you wonder if you are right. Last year, I saw a lecture by a US naval officer about his work after the tsunami off Indonesia and he showed a picture of a CT-guided biopsy of spinal osteomyelitis and they were using one of my biopsy needles.

How has neuroradiology evolved since you began your career?

Everything we do is now “legit” instead of off-label, so it is time to move on to wilder country!

What are the three big questions in interventional neuroradiology that you would like to see the answers to?

The three big questions I would like to see answered are:

• How do we navigate in the cerebral ventricles and stent the Acqueduct of Sylvius?
• What does cerebrospinal fluid really do?
• How do I cool the brain in stroke?

What have been your most memorable clinical cases?

I have had many tough cases at (Johns) Hopkins in those 10 years from 1998 to 2008.

Phillppe Gailloud was my then fellow attending. One night, we had a hell of a case—a truck driver had a basilar thrombosis a left vertebral artery stenosis, a right vertrebral artery occlusion, a left carotid occlusion and a right carotid severe stenosis. I needed stents and had none. I went upstairs at about 2am, tried to get into the cardiology store room and could not. So I lifted up the ceiling tiles and climbed in from the room next to the store, stole the stents and stented his right carotid and his left sublclavian, angioplastied his left vertebral artery and thrombolysed his basilar occlusion.

He did really, really well and was discharged the next day— I was in trouble for messing up the ceiling in cardiology.