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Interventional neurovascular techniques in the treatment of stroke--state-of-the-art therapy
R T Higashida1, F Y Tsai, V V Halbach
1University of California, San Francisco Medical Center, Department of Radiology.
Insights
Interventional neurovascular techniques offer new stroke treatments. These procedures address blockages and spasms, improving blood flow to the brain for patients with acute cerebrovascular insufficiency.
Area of Science:
- Neurology
- Interventional Neuroradiology
Background:
- Acute stroke management traditionally relies on medical therapies.
- Emerging interventional neurovascular techniques are increasingly employed.
Purpose of the Study:
- To review the current applications of interventional neurovascular techniques in acute stroke.
- To highlight the benefits and expanding indications of these procedures.
Main Methods:
- Cerebral percutaneous transluminal angioplasty for stenosis.
- Microcatheter-guided thrombolysis for embolic occlusions.
- Balloon angioplasty for acute arterial vasospasm.
Main Results:
- Percutaneous transluminal angioplasty shows benefit in extracranial and intracranial stenosis.
- Successful thrombolysis, recanalization, and reperfusion achieved in embolic occlusions.
- Balloon angioplasty effective for refractory vasospasm post-subarachnoid hemorrhage.
Conclusions:
- Interventional neurovascular techniques are transforming acute stroke care.
- These methods broaden therapeutic options for cerebrovascular insufficiency.
- Expanding clinical experience will likely broaden indications for these interventions.
Abstract:
Interventional neurovascular techniques for the treatment of patients presenting with symptoms of acute or impending stroke, are now being utilized with increasing frequency in three major areas. (i) For patients presenting with cerebrovascular ischaemic symptoms due to haemodynamically significant stenosis from atherosclerosis, vasculitis, intimal hyperplasia, and dissection, cerebral percutaneous transluminal angioplasty has been shown to be beneficial for both extracranial and intracranial disease. (ii) Patients with acute, embolic occlusion of the internal carotid, middle cerebral, distal vertebral, and basilar arteries have been successfully treated by placement of microcatheters directly into the thrombus with successful thrombolysis, recanalization, and reperfusion to the distal ischemic brain. (iii) Acute arterial vasospasm secondary to subarachnoid haemorrhage is now being managed by balloon angioplasty in those instances where conventional medical therapy has failed. These techniques are altering our current management and broadening the therapeutic alternatives for patients who present with acute cerebrovascular insufficiency and stroke in evolution. As wider experience is gained in these techniques, the clinical indications for their use will also broaden.