Interventional techniques in the management of disorders of the brain: current status

The role, techniques and tools of interventional neuroradiology are growing rapidly because of the number of active investigators. Training programs are being certified by the American Society of Neuroradiology. Recommendations are that Interventional Neuroradiologists be fully qualified in neuroradiology (two years) and have a one or two-year additional fellowship in interventional. The ideal interventionalist would also have some clinical neuroscience training. While these training requirements seem excessive on the surface one must recognize that with the overall drop in routine angiography that a longer exposure is necessary to acquire the prerequisite knowledge, skill and experience easily obtained in one year ten years ago. In fact there has been some pressure to place all of diagnostic neuroangiography in the hands of interventionalists. Endovascular approaches are the treatment of choice for: (1) cerebral vasospasm, (2) carotid cavernous fistulae, (3) vertebral artery origin stenosis, (4) subclavian artery stenosis, (5) innominate and left carotid origin stenosis, and (6) giant intracranial aneurysms. Endovascular treatment is developmental and should be restricted to centers performing formal trials in the treatment of: (1) cerebral arteriovenous malformations and (2) internal carotid artery and intracranial stenosis.