Neuroimaging clinics of North America
-
Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of cerebral vasospasm: vasodilators and angioplasty.
Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a delayed, reversible narrowing of the intracranial vasculature that occurs most commonly 4 to 14 days after aneurysmal SAH and can lead to permanent ischemic injury. Angiographic spasm occurs in up to 70% of patients following SAH, and approximately half become symptomatic. Estimates of patients who are disabled by vasospasm, or die because of it, range from 5% to 9%, with vasospasm accounting for 12% to 17% of all fatalities or cases of disability after SAH. This article discusses the multiple medical and endovascular therapies used to prevent or treat vasospasm.
-
Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of intracranial atherosclerotic disease.
Stroke is the third leading cause of death in the United States. Intracranial atherosclerotic disease plays a role in cerebrovascular accidents, with well-characterized modifiable and nonmodifiable risk factors. ⋯ Initial reports on the results of stent placement for symptomatic high-grade intracranial atherosclerotic disease were initially encouraging. However, debate remains as to the optimal treatment of symptomatic intracranial atherosclerotic disease.
-
Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of cerebral arteriovenous malformations.
Treatment of arteriovenous malformations of the central nervous system requires a multidisciplinary approach with input from vascular neurosurgeons, endovascular interventionalists, and radiation oncologists. Treatment paradigms based on a thorough understanding of the natural history of the lesion and the cumulative risks of multimodality treatment maximize the likelihood of a positive outcome. This article outlines the role of endovascular embolization in the treatment of arteriovenous malformations with specific emphasis on decision making during treatment planning. Technical considerations when treating arteriovenous malformations are discussed, including the choice of embolic agents, potential intraprocedural and periprocedural complications, and postprocedural management of patients.
-
Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of cerebral dural and pial arteriovenous fistulas.
Dural arteriovenous fistulas (DAVFs) are arteriovenous shunts from a dural arterial supply to a dural venous channel, typically supplied by pachymeningeal arteries and located near a major venous sinus. Pial arteriovenous fistulas (PAVFs) are composed of one or more arterial feeders draining into a single vein in the absence of an intervening nidus. Fistulas manifesting features of high risk for rupture should be treated aggressively, the spectrum of treatment varies from endovascular, surgical resection, and stereotactic radiosurgery. This article describes the natural history, clinical presentation, and treatment of dural and pial fistulas, with emphasis on endovascular treatment.
-
Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular methods for the treatment of vascular anomalies.
Vascular malformations are congenital lesions secondary to errors in the development of arteries, capillaries, veins, or lymphatics. Most of these lesions are sporadic; however, a certain percentage present with syndromes. ⋯ The percutaneous/endovascular treatment of each of the vascular anomalies is described, and surgical and additional treatment options are discussed briefly. The clinical outcomes of the main forms of treatment and level of evidence are presented.