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Published on: October 20, 2017
Destructive strategies in treating cerebrovascular pathology: Review and treatment algorithm
J Zakaria1, S-M Gonzalez2, J C Serrone3
1Loyola University Health System, Department of Neurosurgery, Maywood, IL, United States.
Insights
Parent vessel occlusion is a safe and effective destructive strategy for cerebrovascular pathology, including aneurysms and vascular injuries. Careful patient selection and technique are key to minimizing risks and achieving successful outcomes.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Cerebrovascular pathology treatment aims to eradicate lesions with minimal morbidity.
- Destructive strategies like parent vessel occlusion are less common currently.
- Reviewing principles and applications of parent vessel occlusion is crucial.
Purpose of the Study:
- To review the principles of parent vessel occlusion for cerebrovascular pathology.
- To demonstrate the application of these principles through case examples.
- To highlight the continued relevance of destructive strategies in select cases.
Main Methods:
- Review of principles for parent vessel occlusion.
- Selection of cases illustrating these principles.
- Discussion of techniques to avoid procedural morbidity.
Main Results:
- Parent vessel occlusion effectively treats intracranial aneurysms, traumatic injuries, and oncologic indications.
- Key factors for safe occlusion include collateral assessment, eloquence determination, and emboli prevention.
- An algorithm aids in case selection for destructive versus reconstructive approaches.
Conclusions:
- Destructive strategies, specifically parent vessel occlusion, remain relevant for cerebrovascular pathology.
- Appropriate patient selection and meticulous technique ensure safety and efficacy.
- These methods offer viable treatment options for specific cerebrovascular conditions.
Abstract:
The goal of cerebrovascular pathology treatment is most often to angiographically eradicate a lesion with the lowest probability of morbidity. Destructive strategies using parent vessel occlusion are less commonly considered in the modern era. We review principles of parent vessel occlusion for treatment of cerebrovascular pathology and select cases to demonstrate these principles. Many common cerebrovascular conditions have been safely and effectively treated with destructive strategies including intracranial aneurysms, traumatic craniocervical vascular injuries, and oncologic indications such as carotid blowout. Avoiding procedural morbidity in these procedures involves assessment of collaterals distal to a planned parent vessel occlusion, determination of this arterial segment's eloquence, prevention of distal migration of endovascular devices or thrombus, and prevention of stump emboli. An algorithm for case selection and method of destructive technique versus a reconstructive approach can be used. Destructive strategies for treating cerebrovascular pathology are still relevant and can be applied safely in appropriately selected cases.
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