New developments in cerebrovascular surgery

Major changes in the treatment of various cerebrovascular disorders have occurred with improvement and maturation of endovascular techniques. Embolization of intracranial aneurysms, angioplasty and stenting of extracranial and intracranial stenosis, as well as local intra-arterial delivery of thrombolytic agents in patients with acute stroke, are therapeutic modalities that are now widely available, with encouraging preliminary results. Pooling and analysis of the immense amount of data generated by the major carotid endarterectomy trials are defining particular subgroups of patients with carotid stenosis who are at higher risk of stroke who might particularly benefit from the operation. Unfortunately, no significant improvements have occurred in the treatment of some other conditions, such as parenchymal arteriovenous malformations and intracerebral hemorrhage.