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
