This book covers the intersections between neurointervention and neurology, neurointervention and neurosurgery, and neurointervention and other specialties. It fills the gap in the literature by placing specific emphasis on appropriate patient selection, preparation, and post-procedural management.
Concise and comprehensive, this text covers the increasingly important aspects of the neurointerventionalist profession, as it has moved away from a purely technical role to a focus on clinical care. In addition, the most rapidly expanding area of neurointervention, ischemic stroke, is thoroughly examined in this text, where other texts on this subject fail. It is also meant as a reference for non-neurointerventionalists who may desire to learn more about how their patients can benefit from the therapeutic or adjunctive techniques that the neurointerventionalist can provide.
Neurointervention in the Medical Specialties, Second Edition is an essential guide written for neurointerventional specialists from all backgrounds, both in practice and in training
Author(s): Randall C. Edgell, Kara M. Christopher
Series: Current Clinical Neurology
Edition: 2
Publisher: Humana
Year: 2022
Language: English
Pages: 295
City: New York
Contents
Contributors
1: The Neurointerventional Toolkit
Introduction
Contrast Agents
Nonionic Contrast Agents
Femoral Artery Sheath Types
Radial Artery Sheath Types
Wires and Catheters
Diagnostic Cerebral Angiography
Guide Catheters, Intermediate Catheters, and Microcatheters
Coils
Liquid Embolic Materials
Particulate Embolics
Stents
Mechanical Clot Retrievers
Closure Devices
References
2: Neurovascular Anatomy
Arterial Supply of the Head and Neck
Aortic Arch
External Carotid Artery
External Carotid: Internal Carotid Anastomoses
Internal Carotid Artery
Cervical (C1)
Petrous (C2)
Lacerum (C3)
Cavernous (C4)
Clinoid (C5)
Ophthalmic (C6)
Communicating (C7)
The Circle of Willis
Anterior Cerebral Artery
Middle Cerebral Artery
Posterior Cerebral Artery
The Vertebrobasilar System
Vertebral Artery
Basilar Artery
Venous Drainage of the Head and Neck
Extracranial Veins
Dural Venous Sinuses (See Chap. 8)
The Cerebral Veins
References
3: Intensive Care of the Neurointerventional Patient
Introduction
Pre-procedural Care
Fasting
Hydration
Renal Protection
Post-procedural Care
Vascular Access Site Complications
Hematoma
Pseudoaneurysm
Arteriovenous Fistula (AVF)
Infection
Stroke Thrombectomy (See Chap. 7)
Blood Pressure Management
Intracranial Hemorrhage
Intracranial Pressure (ICP) Management
Medical
Hemicraniectomy
Antithrombotic Use Post-thrombectomy
Subarachnoid Hemorrhage (See Chap. 11)
BP Management
Vasospasm
Medical Management
Cardiopulmonary Complications
Fever
Anemia
Hyponatremia
Carotid Stenting (CAS) (See Chap. 4)
Cardiovascular Complications
Ischemic Complications
Cerebral Hyperperfusion Syndrome (CHS) and Intracerebral Hemorrhage
Contrast Encephalopathy
Intracranial Embolization Procedures
References
4: Endovascular Treatment of Extracranial Disease
Cervical Carotid Artery Disease
High-Surgical-Risk Patients
Low-Surgical-Risk Patients
Other Considerations
Predictors of Complications
General Technique
Procedural Considerations
Management of Complications During CAS
Illustrative Case 1
Extracranial Vertebral Artery Stenosis
General Technique
Illustrative Case 2
Great Vessel Stenosis
General Technique
References
5: Endovascular Treatment of Intracranial Atherosclerosis
Introduction
Natural History/Epidemiology
Clinical Presentations
Differential Diagnosis
Mechanisms of Symptoms
Stenosis Characterization
Surgical Treatment of Intracranial Stenosis
Medical Treatment of Intracranial Atherosclerotic Stenosis
Endovascular Treatment of Intracranial Atherosclerotic Stenosis
Intracranial Balloon Angioplasty Without Stenting
Balloon-Mounted Stents
Self-Expanding Stents
Drug-Eluting Stents
Procedural Considerations
Patient Selection
Pre-procedure
Anesthesia
Sheaths
Guiding Catheters
Intermediate Catheters
Microcatheters
Microwires
Balloons
Stents
Procedural Steps
Post-procedural Considerations
Endovascular ICAD Studies
Summary and Future Directions
References
6: Triage of Stroke Patients for Urgent Intervention
Introduction
Cerebral Ischemia and Infarction
Depth of Ischemia
Distribution of Ischemia
Duration of Ischemia
The Ideal Therapeutic Profile: High Value Target
Clinical Syndrome
Ischemic Penumbra Mismatch
Large Arterial Occlusion
Tools Review
Clinical Assessment
Estimation of Ischemic Mismatch: Perfusion Imaging
Documentation of the Occlusive Process: MR and CT Angiography
Optimal Triage Workflow
References
7: Endovascular Reperfusion of Acute Large Vessel Occlusion Stroke
Introduction
Endovascular Recanalization Techniques
Intra-Arterial Thrombolysis
Mechanical Thrombectomy Devices
Merci Retriever
Direct Aspiration Systems
Retrievable Stents (Stentrievers)
Combined Aspiration and Stentriever
Technical Considerations
Pre-Procedural Preparation (See Chap. 6)
Tool Review (See Chap. 1)
Chemical Thrombolysis
Mechanical Devices
Acute Middle Cerebral Artery Occlusion
Illustrative Case 1 (MCA Occlusion)
Acute Vertebrobasilar Occlusion
Illustrative Case 2 (Basilar Occlusion)
Carotid-T Occlusions
Illustrative Case 3 (Carotid-T Occlusion)
Tandem ICA/MCA Occlusions
Illustrative Case 4 (Tandem ICA/MCA Occlusion)
Acute Large Artery Occlusion in Anticoagulated Patients
Complications Associated with IAT in Ischemic Stroke (See Chap. 3)
Periprocedural Management (See Chap. 3)
Conclusion
References
8: Endovascular Treatment of Cerebral Sinus Thrombosis
Introduction
Anatomy/Pathophysiology (See Chap. 2)
Clinical Presentation
Clinical Features
Radiological Features
Medical and Surgical Management
Endovascular Treatment
Patient Selection
Tool Review (See Chap. 1)
Procedural Steps
Illustrative Case 1
References
9: Rare but Interesting: Wada Testing and Inferior Petrosal Sinus Sampling
Wada Testing
Introduction
Procedural Steps
Patient Preparation
Patient Positioning and Access
Pre-Procedure Angiography
Special Anatomical Considerations (See Chap. 2)
Fetal PCA
Persistent Carotid–Basilar Anastomosis
Absent or Atretic A1
Carotid Occlusion
Intracarotid Barbiturate Injections
Potential Pitfalls
Seizure
Pediatric Patient Testing
Pharmacology
Methohexital (Brevital)
Amobarbital (Amytal)
Etomidate (Amidate)
Propofol (Diprivan)
Lidocaine
Superselective Wada Testing
Superselective P2 Injections
Superselective MCA Injections
Illustrative Case 1
Inferior Petrosal Sinus Sampling
Introduction
Clinical Features
References
10: Unruptured Intracranial Aneurysms
Introduction
Natural History
Size
Location
Morphology
Presenting Symptoms and Comorbidities
Future Advances
Noninvasive Management
Surgical Management
Small and Large Aneurysms
Endovascular Management
Equipment Review
Small and Large Aneurysms
Giant Aneurysms
Conclusion
References
11: Ruptured Cerebral Aneurysms
Introduction
Risk Factors
Risk of Rupture
Pathogenesis
Clinical Presentation
Diagnosis
Angiographic Detection and Evaluation
Acute Management
Stabilization (See Chap. 3)
Complications
Rebleeding and Treatment of the Ruptured Aneurysm
Aneurysm Repair
Endovascular Treatment
Procedural Considerations
Patient Selection
Anesthesia
Tools Review
Procedural Steps
Illustrative Case 1
Illustrative Case 2
Endovascular Management of Cerebral Vasospasm
Patient Selection
Anesthesia
Tools Review (See Chap. 1)
Procedural Steps (See Fig. 11.3)
Post-procedural Considerations
Illustrative Case 3
References
12: Arteriovenous Malformations of the Brain
Introduction
Epidemiology
Natural History
Morbidity/Mortality
Clinical Presentation
Diagnosis
Therapeutic Decision-Making
Classification
Microsurgery
Endovascular Treatment
Introduction
Embolization Strategy
Tools Review: Embolic Agents
EVOH Versus n-BCA
AVM-Associated Aneurysms
Complications and Risks of Endovascular Treatment
Procedural Considerations
Procedural Steps
Additional Neuro-endovascular Modalities
Transvenous Approach
Pressure Cooker Technique
Post-procedural Considerations
Stereotactic Radiosurgery
SRS Treatment Strategy
Complications and Risks of SRS Treatment
Conclusion
References
13: Intracranial Dural Arteriovenous Fistula
Introduction
Epidemiology
Pathophysiology of Formation
Clinical Presentation
Differential Diagnosis
Imaging Evaluations
Non-contrast Computed Tomography
CT Angiography
Magnetic Resonance Imaging
MR Angiography
Four-Dimensional (Time-Resolved) CT Angiography and MR Angiography
Digital Subtraction Angiography
Natural History
Treatment Strategies for DAVF
Endovascular Treatment
Transarterial Approach
Transvenous Approach
Open Surgical Treatments
Stereotactic Radiosurgery (SRS)
References
14: Preoperative Tumor Embolization
Introduction
Tool Review (See Chap. 1)
Embolisates
Provocative Testing (See Chap. 9)
General Technique
Risks
Neoplastic Vascular Lesions
Hemangioma
Hemangioblastoma
Meningioma
Illustrative Case 1
Juvenile Nasopharyngeal Angiofibroma
Illustrative Case 2: Juvenile Nasal Angiofibroma
Glomus Tumors
Hemangiopericytoma
Endolymphatic Sac Tumors
References
15: Neurointervention in Ophthalmologic Disorders
Cerebral Aneurysm
Introduction
Clinical Manifestations
Carotid-Cavernous Fistula
Introduction
Clinical Manifestation
Radiographic Features
Management of CCF
Endovascular Treatment
Illustrative Case 1
Idiopathic Intracranial Hypertension
Introduction
Clinical Manifestation
Investigation and Diagnosis
Management
Endovascular Treatment
Periprocedural Steps
Illustrative Case 2
References
16: Neurointervention and the Otolaryngologist: Head and Neck Surgeon
Introduction
Tools Review (See Chap. 1)
Coils
Particulate Embolics
Liquid Embolics
Balloon Test Occlusion
Indications
General Technique
Predictive Value
Risks
Technical Variations
Carotid Blowout Syndrome
Causes
Epidemiology
Clinical Presentation
Indications for Invasive Treatment
Risks
Surgical Approach
Endovascular Approach
Case Study 1: Carotid Blowout
Epistaxis
Epidemiology
Associated Conditions
Stepwise Treatment Algorithm [29]
Angiographic Assessment
Surgical/Endoscopic Treatment
Endovascular Treatment
Efficacy
Risks
Illustrative Case 2: Epistaxis
Preoperative Tumor Embolization
General Technique
Risks
Vascular Tumors
Radiation-Induced Carotid Stenosis
Association of Carotid Stenosis and Radiation
Pathophysiology
Indications for Treatment (See Chap. 4)
Endovascular Treatment
Iatrogenic Carotid Injury
Persistent Stapedial Artery and Aberrant Course of the ICA
Illustrative Case 3: Aberrant ICA
Injury During Sinus Surgery
Illustrative Case 4
References
17: The Role of Neurointervention in Traumatic Vascular Injury and Vascular Surgery
Introduction
Screening for Vascular Injury
Penetrating Injuries
Blunt Injuries
Carotid Artery Dissection
Case Study
Carotid Cavernous Fistula (See Chap. 15)
Vertebral Artery Dissection
Postoperative Large Vessel Stroke (See Chaps. 6 and 7)
Incidental Intracranial Abnormalities
Atherosclerotic Stenosis (See Chaps. 4 and 5)
Aneurysms (See Chap. 10)
Dural Arteriovenous Fistula (See Chaps. 13 and 15)
Role of Transcarotid Artery Revascularization (TCAR) with Flow Reversal (See Chap. 4)
Procedural Steps
References
18: Future of Aneurysm Surgery: Flow Disruption
Aneurysm Characteristics
Cerebral Aneurysm Types and Morphology
Aneurysm Size and Location
Aneurysm Physiology and Flow Dynamics
Treatment of Wide Neck and Bifurcation Aneurysm
Intrasaccular Flow Disruptors
Woven EndoBridge (Microvention, Aliso Viejo, California)
Medina Embolic Device (Medtronic, Dublin, Ireland)
Artisse (Medtronic, Dublin, Ireland)
Contour Neurovascular System (Cerus Endovascular, Fremont, California)
Neqstent (Cerus Endovascular, Fremont, California)
Seal GT (Galaxy Therapeutics, Brookfield, WI)
Future of Intrasaccular Flow Disruptors
References
19: On the Horizon: Innovative Techniques and Procedures
Introduction
Beyond Femoral Access
Endovascular Treatment of Central Retinal Artery Occlusion
Middle Meningeal Artery Embolization for Chronic Subdural Hematomas
Endovascular Treatment of Headache
Endovascular Neuro-Oncology
Endovascular Treatment of Intracranial Hypertension
Endovascular Neuromodulation
Direct Intravascular Visualization
Robotic Neurointerventional Techniques
Artificial Intelligence and Neurointervention
Conclusion
References
Index
