Doctors who interpret X-rays and other imaging modalities may also be much more involved in the treatment of the underlying problem.  This specialty, called  'interventional radiology'  has become more common in the last two decades and has led to complex and difficult procedures done from 'inside' the blood vessel (also called endovascular) during blood vessel X-rays. Some of these procedures have replaced or complemented some standard neurosurgical and vascular procedures that have previously used intraoperative monitoring, such as brain aneurysm (a small bulge or ballooning in a blood vessel) treatment. Arterial stenting (inserting an artificial tube into an artery to improve blood-flow) involving the carotid (an artery that supplies blood to the neck and head) and other arteries is also becoming increasingly available and popular.

IONM is also used to monitor endovascular procedures where there is a risk of a clot breaking off and traveling down the blood vessel, or rupture or blockage of the vessel for which there is a corrective treatment such as blood thinners (anticoagulation) or surgery, and for which there is a reason that the status of the nervous system cannot be easily followed clinically, such as a need to sedate or anesthetize the patient.

Selected References
Liu, A. Y.; Lopez, J. R.; Do, H. M.; Steinberg, G. K.; Cockroft, K. & Marks, M. P. (2003), 'Neurophysiological monitoring in the endovascular therapy of aneurysms.', AJNR Am J Neuroradiol 24(8), 1520--1527.Rohde, V.; Will, B. E.; Hahn, G.; Bien, S. & Zentner, J. (1999), '[Motor evoked potentials during embolization of arteriovenous malformations for the detection of ischemic complications]', Zentralbl Neurochir 60(2), 74--80.Sala, F.; Niimi, Y.; Berenstein, A. & Deletis, V. (2001), 'Neuroprotective role of neurophysiological monitoring during endovascular procedures in the spinal cord.', Ann N Y Acad Sci 939, 126--136.