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Interventional Techniques
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
This chapter reviews the role of interventional neuroradiology (INR) in the management of patients with pathologies of the head and neck and describes common techniques. Endovascular embolization originated in surgery when Brooks1 closed a cavernous-carotid fistula with a muscle embolus introduced by arteriotomy in 1930. The need for vascular imaging to monitor embolization was obvious, but the capacity developed slowly after the first description of cerebral angiography by Egas Moniz in 1927.2 As a result, embolization for head and neck pathologies is generally performed in Neuroradiology departments.
Understanding neuroradiology
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
The practice of interventional neuroradiology comprises diagnostic neuroangiography and neurointerventional procedures. Since it is based on plain radiography, it evolved early in the history of neuroradiology, well before the advent of cross-sectional imaging. The technique of cerebral angiography was first developed in 1927 by the Portuguese physician Egas Moniz at the University of Lisbon. The practice of therapeutic neurointervention started in the 1960s and has made rapid strides in recent decades.
Central nervous system
Published in David A Lisle, Imaging for Students, 2012
The basic tool of interventional neuroradiology is the microcatheter. Microcatheters can be advanced coaxially through larger catheters to access vascular pathology deep in the brain. Interventional neuroradiology encompasses a variety of endovascular techniques and indications, including:Coil embolization of aneurysms and occlusion of intracerebral AVMs, usually in the setting of SAH (Fig. 10.18)Intra-arterial infusion of vasodilator drugs for management of cerebral vasospasm, usually in the setting of subarachnoid haemorrhageIntra-arterial infusion of tPA in the treatment of strokeIntra-arterial infusion of tPA has the theoretical advantage of achieving recanalization of thrombosed arteries with use of a lower dose than with intravenous infusion, and therefore potentially fewer complicationsMechanical devices for removal of thrombus from occluded arteriesAngioplasty and arterial stenting in the management of atherosclerotic disease of the carotid and intracerebral arteries.
Management of aneurysmal subarachnoid haemorrhage 17 years after the ISAT trial: a survey of current practice in the UK and Ireland
Published in British Journal of Neurosurgery, 2020
Mark Jernej Zorman, Robert Iorga, Ruichong Ma, Umang Jash Patel
The central recommendation of NCEPOD was to ensure the availability of interventional neuroradiology services such that hospitals can comply with the National Clinical Guideline for Stroke stating that aneurysm repair should be available within 48 hours of presentation with aSAH. This is because treatment delayed for more than 48 hours led to significantly increased rates of re-bleeding, complications, disability and death.4 In comparison with other developed countries such as the USA, the UK centres historically had a longer interval from diagnosis to treatment of aSAH.1,8 The UK data collected over the last two decades (Table 1) suggests that the percentage of centres claiming to provide treatment of ruptured aneurysms within 48h of ictus increased from 32% in 2002 to 74% in 2014. The results of this survey suggest that whilst only 9 (28%) of units provide 7 day a week interventional radiology service, all 32 (100%) units have established networks with other neuroradiology centres and can provide aSAH treatment within 48h provided there are no delays in transferring patients between centres. This shows an important improvement in management of aSAH. Nevertheless, a number of interventional neuroradiology units reported being understaffed, a problem consistent with a current shortage of interventional neuroradiologists in the British Isles.
Comparison of stents used for endovascular treatment of intracranial aneurysms
Published in Expert Review of Medical Devices, 2018
Benjamin Mine, Thomas Bonnet, Juan Carlos Vazquez-Suarez, Christina Iosif, Boris Lubicz
SAC is a major milestone in the development of interventional neuroradiology because it has widened the indications of EVT and improved its results.Stents dedicated to the EVT of IA may be classified as laser-cut or braided devices.Among the laser-cut stents, the mesh is organized either following a closed-cell or an open-cell design.Several devices are available on the market and neurointerventionalists should be aware of their specificities to optimize EVT of IA in every clinical situation.The first evolutions over the last 20 years have allowed to significantly improve navigability and apposition of the stents.Further developments should aim to improve the deployment and the stent tolerance regarding platelet aggregation. These developments could be based on new materials such as bioresorbable and/or coated scaffolds or alloy with improved radiopacity.
Mechanical thrombectomy – is time still brain? The DAWN of a new era
Published in British Journal of Neurosurgery, 2018
Naveed Kamal, Neil Majmundar, Nitesh Damadora, Mohammad El-Ghanem, Rolla Nuoman, Irwin A. Keller, Steven Schonfeld, Igor Rybinnik, Gaurav Gupta, Sudipta Roychowdry, Fawaz Al-Mufti
With a primary focus on the endovascular management of stroke, it is important to appreciate the history of the field, nascent as a subspecialty of radiology to a multidisciplinary team of neurosurgeons, neurologists, and radiologists. Interventional neuroradiology was created in the 1980s to allow for novel approaches to certain diseases, such as giant or inaccessible cerebral aneurysms and arteriovenous malformations, where traditional open surgery was not feasible.6 Due to the rapid evolution of treatment options, neuroendovascular surgery has become a staple in the management of cerebrovascular disease with a surge of neurologists and neurosurgeons being trained in such techniques. Although the majority of current endovascular practitioners are neuroradiologists, one study found that the number of neurosurgeons and neurologists entering the field has increased by 42.5% and 112%, respectively, thus representing a change in the landscape.7 As we seek to improve the treatment of acute ischemic stroke, neurologists and neurosurgeons trained in endovascular techniques will take on a more active role in providing thrombectomy and endovascular intervention.