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Indications and Recommendations for Intracranial Endovascular Neurointerventional Procedures |
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Written by G. Firman MD
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Monday, 29 November 2010 07:33 |
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Intracranial endovascular cerebrovascular interventions treat cerebrovascular diseases by use of minimally invasive intravascular techniques.
Indications and Recommendations for Endovascular Procedures | | Indications | Recommendations | | Cerebral aneurysm | | Ruptured with SAH | If amenable to endovascular treatment according
to endovascular specialist | Should be considered for endovascular
occlusion | | Unruptured | If amenable to endovascular treatment according
to endovascular specialist | Reasonable to consider endovascular
occlusion | | Intracranial atherosclerosis | | Symptomatic stenosis | For symptomatic atherosclerotic stenosis >70%
failing medical therapy | May be reasonable to consider endovascular
revascularization with angioplasty or stenting | | Acute ischemic stroke | Intra-arterial
thrombolysis | For patients with major stroke syndrome of <6
hours’ duration and ineligible for intravenous
thrombolysis | Reasonable to consider intra-arterial
thrombolysis in selected patients | | Mechanical disruption | For patients with major stroke syndrome of <8
hours’ duration and ineligible for or failing
intravenous thrombolysis | May be reasonable to perform mechanical
disruption to restore cerebral blood flow in
selected patients | | Cerebral AVM | | Pial AVM | For patients with hemorrhage referable to the
AVM, endovascular treatment in combination
with other therapies such as surgery or
radiosurgery | May be considered as a preoperative
adjunct or palliative treatment in an effort to
prevent recurrent hemorrhage | | Dural AV fistula | For patients with neurological symptoms or
hemorrhage referable to the AVM, endovascular
treatment alone may be curative or may be used
in combination with other therapies such as
surgery or radiosurgery | May be considered as a preoperative
adjunct or palliative treatment in an effort to
prevent stroke or hemorrhage |
SAH indicates subarachnoid hemorrhage; AVM, arteriovenous malformation.
References: - Meyers PM, Schumacher HC, Higashida RT, Barnwell SL, Creager MA, Gupta R, McDougall CG, Pandey DK, Sacks D, Wechsler LR; American Heart Association. Indications for the performance of intracranial endovascular neurointerventional procedures: a scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation. 2009 Apr 28;119(16):2235-49 [Medline]
- Qureshi AI, Abou-Chebl A, Jovin TG. Qualification requirements for performing neurointerventional procedures: a Report of the Practice Guidelines Committee of the American Society of Neuroimaging and the Society of Vascular and Interventional Neurology. J Neuroimaging. 2008 Oct;18(4):433-47. [Medline]
Created: Nov 29, 2010
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