+ All Categories
Home > Health & Medicine > Endovascular neurosurgery

Endovascular neurosurgery

Date post: 15-Dec-2014
Category:
Upload: mukhtar-khan
View: 106 times
Download: 3 times
Share this document with a friend
Description:
a brief overview of the available neurosurgical endovasuclar solutions for vascualr diseases of the brain
Popular Tags:
13
Transcript
  • 1. Endovascular Neurosurgery Dr Mukhtar Neurosurgery HMC

2. Aims Introduction to endovascular neurosurgery Importance of endovascular neurosurgery Basic know how of endovascular neurosurgery Commonly performed neuro-endovascular procedures Video illustrations Current advancements 3. Introduction Subspecialty of Neurosurgery which specializes in minimally invasive image-based technologies and procedures used in diagnosis and treatment of diseases of the head, neck, and spine Greater developments over the past two decades Incorporation into neurosurgery curriculum Important alternate therapeutic option to open surgery or medical therapy 4. General Principles Preprocedural evaluation Detailed neurovascular history & exam Baseline investigations Antiplatelet therapy Aspirin / Clopidogrel / Eptifibatide Contrast agents iohexol / iodixanol / iopromide 5. General Principles Femoral Artery Puncture 6. Intervention for Ischemic stroke Candidates Time window: 6 -8 hours *PROACT/Penumbra trials Techniques: Pharmacological => t-PA Mechanical: Microwire (Merci & Penumbra) Stent-assisted or stent-platform-based 7. Intracranial atherosclerosis 8% to 10% of ischemic strokes are attributable to intracranial atherosclerosis Need for treatment? The WASID trial found an 11% to 12% first-year risk of ischemic stroke in territory attributable to the patient symptoms majority of strokes (73%) in WASID patients were in the territory of the stenotic artery Endovascular Tools and Technique The Wingspan Stent System 8. Carotid angioplasty and stenting 30% of ischemic strokes. Carotid endarterectomy is the conventional procedure Patients who are unfit for endarterectomy are suitable candidates for CAS The Technique: Preprocedural aortic arch angiogram Selective carotid angiography to assess stenosis severity Femoral puncture and CAS 9. Intracranial aneurysm treatment Endovascular coiling is the conventional minimally invasive procedure Balloon assisted coiling Self-expanding stent assisted coiling Onyx embolization Onyx is composed of an ethylene vinyl alcohol copolymer dissolved in DMSO and suspended in micronized tantalum powder (for visualization under fluoroscopy) Investigational procedure, not licensed 10. Recent advancements 1. AVM embolization with Onyx 2. Vascular tumors embolization Polyvinyl alcohol Gelfoam Coils Trisacryl gelatin microspheres 3. Ischemic Vasospasm Balloon angioplasty 4. Epistaxis 11. References 1. Sabareesh KN, Adnan HS, Hopkins LN. Endovascular Neurosurgery. Principles of Neurological surgery. 3rd ed.. P 362-338 2. del Zoppo GJ, Higashida RT, Furlan AJ, et al. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. PROACT Investigators. Prolyse in acute cerebral thromboembolism. Stroke. 1998;29:4-11. 3. Levy EI, Siddiqui AH, Crumlish A, et al. First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (Stent-Assisted Recanalization in acute Ischemic Stroke). Stroke. 2009;40:3552-3556. 4. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics2010 update: a report from the American Heart Association. Circulation. 2010;121:e46-e215. National 5. Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581-1587. 6. Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493-1501. 7. Report of the WHO Task Force on Stroke and Other Cerebrovascular Disorders, 1989. Recommendations on stroke prevention, diagnosis, and therapy. Stroke. 1989; 20:1407-1431. 8. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics2010 update: a report from the American Heart Association. Circulation. 2010;121:e46-e215. 9. Broderick JP. William M. Feinberg Lecture: stroke therapy in the year 2025: burden, breakthroughs, and barriers to progress. Stroke. 2004;35:205-211. 10. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333: 1581-1587. 12. Thanks


Recommended