Neurosurgery clinics of North America
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Intracranial atherosclerotic disease (ICAD) represents one of the most common causes of ischemic stroke worldwide, yet our understanding remains limited regarding the best treatment options for this complex disease with a high recurrence rate of stroke. Although medical therapy has proved to be effective in lowering the risk of stroke, certain high-risk ICAD patients may derive benefit from endovascular therapy. This review presents the current treatment options for the endovascular management of ICAD and highlights the recent relevant literature.
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Neurosurg. Clin. N. Am. · Jul 2014
ReviewEndovascular management of intracranial dural arteriovenous fistulae.
Endovascular embolization is the primary therapeutic modality for intracranial dural arteriovenous fistulae. Based on access route, endovascular treatment can be schematically divided into transarterial, transvenous, combined, and direct/percutaneous approaches. Choice of access route and technique depends primarily on dural arteriovenous fistulae angioarchitecture, pattern of venous drainage, clinical presentation, and location. Individualized endovascular approaches result in a high degree of cure with a reasonably low complication rate.
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Neurosurg. Clin. N. Am. · Jul 2014
ReviewEndovascular approaches to pial arteriovenous malformations.
Endovascular approaches to arteriovenous malformations (AVMs) are often necessary to define and help treat these often complex lesions. Angiography provides important information to help plan surgical or radiosurgical approaches. Modern embolization techniques allow AVMs to be treated with the goals of making surgery safer and easier, eliminating high-risk features in patients with AVMs who are otherwise not candidates for treatment, and even potentially curing the patient of the lesion. Liquid embolic agents have significantly advanced what is possible with endovascular treatment of AVMs.
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Neurosurg. Clin. N. Am. · Jul 2014
ReviewEndovascular management and treatment of acute ischemic stroke.
Endovascular intra-arterial therapy is reserved for strokes from large vessel occlusion. This article reviews the critical role of the location of the occlusion, extent and characteristics of the occlusive thrombus on noninvasive imaging, and identification of ischemic core and salvageable tissue on perfusion imaging for proper patient selection. The advantages of stentrievers over other mechanical thrombectomy approaches are discussed and the role of the aspiration thrombectomy approach in modern clinical practice is reviewed. Finally, the implications of the results of recent randomized trials of endovascular therapy on the future of intra-arterial revascularization therapies are discussed.
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Neurosurg. Clin. N. Am. · Jul 2014
ReviewPitfalls and complications management in the endovascular treatment of aneurysms.
This article reviews complications associated with the endovascular management of intracranial aneurysms, focusing on risk factors, avoidance, recognition, and management. Such complications can be devastating. Both neurologic and nonneurologic complications can occur. ⋯ Reduction of complication rates can be achieved by careful patient selection, meticulous planning and preparation for the procedure, anticipating potential complications, and preparing for their management. Tracking outcomes and a robust case conference can further enhance outcomes. Education of the care team and a collaborative environment can foster greater focus on avoidance of complications.