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Interventional Neuroradiology

2004; Lippincott Williams & Wilkins; Volume: 35; Issue: 2 Linguagem: Inglês

10.1161/01.str.0000115166.04978.c8

1524-4628

David M. Pelz, Pedro Lylyk, Makoto Negoro,

Cerebrovascular and Carotid Artery Diseases

HomeStrokeVol. 35, No. 2Interventional Neuroradiology Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBInterventional Neuroradiology D. Pelz, MD, FRCPC, P. Lylyk, MD and M. Negoro, MD D. PelzD. Pelz From the Departments of Diagnostic Radiology and Nuclear Medicine and Clinical Neurological Sciences (D.M.P.), London Health Sciences Centre, London, Ontario, Canada; Clinica Medica Belgrano (P.L.), Buenos Aires, Argentina; and the Department of Neurosurgery (M.N.), Fujita Health University School of Medicine, Toyoake, Japan. , P. LylykP. Lylyk From the Departments of Diagnostic Radiology and Nuclear Medicine and Clinical Neurological Sciences (D.M.P.), London Health Sciences Centre, London, Ontario, Canada; Clinica Medica Belgrano (P.L.), Buenos Aires, Argentina; and the Department of Neurosurgery (M.N.), Fujita Health University School of Medicine, Toyoake, Japan. and M. NegoroM. Negoro From the Departments of Diagnostic Radiology and Nuclear Medicine and Clinical Neurological Sciences (D.M.P.), London Health Sciences Centre, London, Ontario, Canada; Clinica Medica Belgrano (P.L.), Buenos Aires, Argentina; and the Department of Neurosurgery (M.N.), Fujita Health University School of Medicine, Toyoake, Japan. Originally published1 Feb 2004https://doi.org/10.1161/01.STR.0000115166.04978.C8Stroke. 2004;35:381–382The year 2003 in interventional neuroradiology has been one of innovation, reflection, and anticipation. Innovation with the development of new devices for aneurysm therapy and carotid stenting, reflection on the results of the International Subarachnoid Aneurysm Study (ISAT) and the International Study of Unruptured Intracranial Aneurysms (ISUIA), and anticipation of the results of ongoing carotid stenting (CAS) versus endarterectomy (CEA) trials.Cerebral Aneurysm TherapyHealthy debate regarding optimal aneurysm treatment continues in the wake of ISAT.1 Publication of the ISUIA2 has revealed the benign nature of small ( 10 mm, incomplete initial occlusion, duration of follow-up, and treatment during the acute rupture phase.13 It has also become clear that complication rates in aneurysm therapy are less in high-volume centers15 and that a neurovascular team, comprised of neurosurgeons and endovascular therapists working together, is essential to successfully treat the spectrum of intracranial aneurysms.16–19Carotid Angioplasty and StentingCAS is becoming an increasingly popular procedure, both inside and outside the numerous comparison trials with carotid endarterectomy now underway. Although the results of the largest and most ambitious of these studies, the Carotid Revascularization Endarterectomy versus Stent Trial (CREST), are several years away, an updated worldwide survey20 has shown that >12 000 procedures have been performed, with technical success rates close to 99% and total stroke and death rates <5%. The increasingly common use of cerebral protection devices can lower the complication rates to 7 were 3 times more likely to have an independent functional outcome than those scoring <7. Newer, third-generation thrombolytics such as tenecteplase and reteplase are becoming available, boasting longer half-lives and better penetration into thrombus matrix, which may translate into better recanalization rates in acute stroke.32 Snare retrieval and aggressive mechanical clot disruption may be therapeutic options when chemical thrombolysis fails.33,34 The increasingly routine use of multislice CT to perform cerebral blood flow studies concurrent with CT angiography can facilitate rapid, effective thrombolytic therapy. The goals of reliable imaging of the reversible ischemic penumbra, and prediction of eventual outcome, are not yet attainable in most clinical settings.Arteriovenous MalformationsThere have been few new developments in the endovascular therapy of brain arteriovenous malformations (AVMs). Onyx is gaining popularity as a more controllable embolic agent than n-butyl-cyanoacrylate (NBCA). An interesting review of Spetzler-Martin grade IV and V AVMs from the Barrow Institute35 noted a hemorrhage rate of only 1.5% per year in 73 patients, compared with a 10.4% rate in those who had undergone incomplete therapy, implying that partial treatment of large, complex AVMs may be more damaging than no treatment. The authors reiterate that there is no evidence that partial embolization of AVMs offers any decrease in bleeding rates, and they do not support palliative therapy of any kind unless an intranidal aneurysm is identified or there is a progressive neurological deficit from a vascular steal or hemorrhage. These selection criteria may help to keep the combined morbidity and mortality of these lesions (17% and 22%, respectively) relatively low.The opinions expressed in this editorial are not necessarily those of the editors or of the American Stroke Association.FootnotesCorrespondence to Dr David Pelz, Department of Diagnostic Radiology, London Health Sciences Centre, 339 Windermere Rd, London, Ontario, Canada N6A 5A5. E-mail [email protected] References 1 Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002; 360: 1267–1274.CrossrefMedlineGoogle Scholar2 Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, et al. International study of unruptured intracranial aneurysms. Lancet. 2003; 362: 103–110.CrossrefMedlineGoogle Scholar3 Matsumoto H, Terada T, Tsuura M, Itakura T, Ogawa A. Basic fibroblast growth factor released from a platinum coil with a polyvinyl alcohol core enhances cellular proliferation and vascular wall thickness: an in vitro and in vivo study. Neurosurgery. 2003; 53: 402–407.CrossrefMedlineGoogle Scholar4 Raymond J, Metcalfe A, Desfaits AC, Ribourtout E, Salazkin I, Gilmartin K, Embry G, Boock RJ. Alginate for endovascular treatment of aneurysms and local growth factor delivery. AJNR Am J Neuroradiol. 2003; 24: 1214–1221.MedlineGoogle Scholar5 Kallmes DF, Fugiwara NH, Yuen D, Dai D, Li ST. A collagen-based coil for embolization of saccular aneurysms in a New Zealand White rabbit model. AJNR Am J Neuroradiol. 2003; 24: 591–596.MedlineGoogle Scholar6 Murayama Y, Tateshima S, Gonzalez NR, Vinuela F. Matrix and bioabsorbable polymeric coils accelerate healing of intracranial aneurysms: long-term experimental study. Stroke. 2003; 34: 2031–2037.LinkGoogle Scholar7 Baldi S, Mounayer C, Piotin M, Spelle L, Moret J. Balloon-assisted coil placement in wide-necked bifurcation aneurysms by use of a new, compliant balloon microcatheter. AJNR Am J Neuroradiol. 2003; 24: 1222–1225.MedlineGoogle Scholar8 Wanke I, Doerfler A, Schoch B, Stolke D, Forsting M. Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience. AJNR Am J Neuroradiol. 2003; 24: 1192–1199.MedlineGoogle Scholar9 Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C. Endovascular reconstruction of intracranial arteries by stent placement and combined techniques. J Neurosurg. 2002; 97: 1306–1313.CrossrefMedlineGoogle Scholar10 Broadbent LP, Moran CJ, Cross DW 3rd, Derdeyn CP. Management of Neuroform stent dislodgement and misplacement. AJNR Am J Neuroradiol. 2003; 24: 1819–1822.MedlineGoogle Scholar11 Piotin M, Gailloud P, Bidault L, Mandai S, Muster M, Moret J, Rufenacht DA. 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In-hospital morbidity and mortality after endovascular treatment of unruptured intracranial aneurysms in the United States, 1996–2000: effect of hospital and physician volume. AJNR Am J Neuroradiol. 2003; 24: 1409–1420.MedlineGoogle Scholar16 Lawton MT, Quinones-Hinojosa A, Sanai N, Malek JY, Dowd CF. Combined microsurgical and endovascular management of complex intracranial aneurysms. Neurosurgery. 2003; 52: 263–274.CrossrefMedlineGoogle Scholar17 Hoh BL, Carter BS, Putnam CM, Ogilvy CS. Important factors for a combined neurovascular team to consider in selecting a treatment modality for patients with previously clipped residual and recurrent intracranial aneurysms. Neurosurgery. 2003; 52: 732–738.CrossrefMedlineGoogle Scholar18 Zhang YJ, Barrow DL, Cawley CM, Dion J. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy. Neurosurgery. 2003; 52: 283–293.CrossrefMedlineGoogle Scholar19 Proust F, Debono B, Hannequin D, Gerardin E, Clavier E, Langlois O, Freger P. Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures. J Neurosurg. 2003; 99: 3–14.CrossrefMedlineGoogle Scholar20 Wholey MH, Al-Mubarek N. Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interv. 2003; 60: 259–266.CrossrefMedlineGoogle Scholar21 Kastrup A, Groschel K, Krapf H, Brehm BR, Dichgans J, Schultz JB. Early outcome of carotid angioplasty and stenting with and without cerebral protection devices: a systematic review of the literature. Stroke. 2003; 34: 813–819.LinkGoogle Scholar22 Cremonesi A, Manetti R, Setacci F, Setacci C, Castriota F. Protected carotid stenting: clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke. 2003; 34: 1936–1941.LinkGoogle Scholar23 Eckert B, Zeumer H. Carotid artery stenting with or without protection devices? Strong opinions, poor evidence! Stroke. 2003; 34: 1941–1943.LinkGoogle Scholar24 Goldstein LB. Extracranial carotid artery stenosis. Stroke. 2003; 34: 2767–2773.LinkGoogle Scholar25 Yadav J. Stenting and angioplasty with protection in patients at high risk for endarterectomy (The SAPPHIRE Study). AHA Scientific Sessions. November 2002, Chicago, Ill.Google Scholar26 Taylor S, Alcocer F, Jordan WD Jr. Controversies in carotid stenting. Vasc Endovasc Surg. 2003; 37: 79–87.CrossrefMedlineGoogle Scholar27 Lopes DK, Ringer AJ, Boulos AS, Qureshi AI, Lieber BB, Guterman LR, Hopkins LN. Fate of branching arteries after intracranial stenting. Neurosurgery. 2003; 52: 1275–1278.CrossrefMedlineGoogle Scholar28 Del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke. 1998; 29: 4–11.CrossrefMedlineGoogle Scholar29 Higashida RT, Furlan AJ. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003; 34: e109–e137.LinkGoogle Scholar30 Wardlaw JM, del Zoppo G, Yamaguchi T, Berg E. Thrombolysis for acute stroke. Cochrane Database Syst Rev. 2003; 3: CD 000213.Google Scholar31 Hill MD, Rowley HA, Adler F, Eliasziw M, Furlan A, Higashida RT, Wechsler LR, Roberts HC, Dillon WP, Fischbein NJ, et al; PROACT-II Investigators. Selection of acute ischemic stroke patients for intra-arterial thrombolysis with pro-urokinase by using ASPECTS. Stroke. 2003; 34: 1925–1931.LinkGoogle Scholar32 Qureshi AI, Pande RU, Kim SH, Hanel RA, Kirmani JF, Yahia AM. Third generation thrombolytics for the treatment of acute ischemic stroke. Curr Opin Invest Drugs. 2002; 3: 1729–1732.MedlineGoogle Scholar33 Kerber CW, Barr JD, Berger RM, Chopko BW. Snare retrieval of intracranial thrombus in patients with acute stroke. J Vasc Interv Radiol. 2002; 13: 1269–1274.CrossrefMedlineGoogle Scholar34 Qureshi AI, Siddiqui AM, Suri MF, Kim SH, Ali Z, Yahia AM, Lopes DK, Boulos AS, Ringer AJ, Saad M, et al. Aggressive mechanical clot disruption and low-dose intra-arterial third-generation thrombolytic agents for ischemic stroke: a prospective study. Neurosurgery. 2002; 51: 1319–1327.CrossrefMedlineGoogle Scholar35 Han PP, Ponce FA, Spetzler RF. Intention-to-treat analysis of Spetzler-Martin grades IV and V arteriovenous malformations: natural history and treatment paradigm. J Neurosurg. 2003; 98: 3–7.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Small, IV W, Singhal P, Wilson T and Maitland D (2010) Biomedical applications of thermally activated shape memory polymers, Journal of Materials Chemistry, 10.1039/b923717h, 20:17, (3356), . Kau T, Gasser J, Celedin S, Rabitsch E, Eicher W, Uhl E and Hausegger K (2009) MR Angiographic Follow-Up of Intracranial Aneurysms Treated with Detachable Coils: Evaluation of a Blood-Pool Contrast Medium, American Journal of Neuroradiology, 10.3174/ajnr.A1622, 30:8, (1524-1530), Online publication date: 1-Sep-2009. Gauvrit J, Caron S, Taschner C, Lejeune J, Pruvo J and Leclerc X Intracranial aneurysms treated with Guglielmi detachable coils: long-term imaging follow-up with contrast-enhanced magnetic resonance angiography, Journal of Neurosurgery, 10.3171/JNS/2008/108/3/0443, 108:3, (443-449) Small W, Buckley P, Wilson T, Benett W, Hartman J, Saloner D and Maitland D Shape Memory Polymer Stent With Expandable Foam: A New Concept for Endovascular Embolization of Fusiform Aneurysms, IEEE Transactions on Biomedical Engineering, 10.1109/TBME.2006.889771, 54:6, (1157-1160) Gauvrit J, Leclerc X, Caron S, Taschner C, Lejeune J and Pruvo J (2006) Intracranial Aneurysms Treated With Guglielmi Detachable Coils, Stroke, 37:4, (1033-1037), Online publication date: 1-Apr-2006. February 2004Vol 35, Issue 2 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000115166.04978.C8PMID: 14757886 Manuscript receivedNovember 25, 2003Manuscript acceptedDecember 3, 2003Originally publishedFebruary 1, 2004 Keywordsinterventional neuroradiologyAdvances in StrokePDF download Advertisement