1
|
Calixte A, Lartigue S, McGaugh S, Mathelier M, Patel A, Siyanaki MRH, Pierre K, Lucke-Wold B. Neurointerventional Radiology: History, Present and Future. JOURNAL OF RADIOLOGY AND ONCOLOGY 2023; 7:26-32. [PMID: 37795208 PMCID: PMC10550195 DOI: 10.29328/journal.jro.1001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Neurointerventional Radiology (NIR), encompassing neuroendovascular surgery, endovascular neurosurgery, and interventional neurology, is an innovative and rapidly evolving multidisciplinary specialty focused on minimally invasive therapies for a wide range of neurological disorders. This review provides a comprehensive overview of NIR, discussing the three routes into the field, highlighting their distinct training paradigms, and emphasizing the importance of unified approaches through organizations like the Society of Neurointerventional Surgery (SNIS). The paper explores the benefits of co-managed care and its potential to improve patient outcomes, as well as the role of interdisciplinary collaboration and cross-disciplinary integration in advancing the field. We discuss the various contributions of neurosurgery, radiology, and neurology to cerebrovascular surgery, aiming to inform and educate those interested in pursuing a career in neurointervention. Additionally, the review examines the adoption of innovative technologies such as robotic-assisted techniques and artificial intelligence in NIR, and their implications for patient care and the future of the specialty. By presenting a comprehensive analysis of the field of neurointervention, we hope to inspire those considering a career in this exciting and rapidly advancing specialty, and underscore the importance of interdisciplinary collaboration in shaping its future.
Collapse
Affiliation(s)
- Andre Calixte
- New York Medical College, Valhalla, New York, 10595, USA
| | - Schan Lartigue
- New York Medical College, Valhalla, New York, 10595, USA
| | - Scott McGaugh
- University of Florida College of Medicine, Gainesville, Florida, 32608, USA
| | - Michael Mathelier
- University of Florida College of Medicine, Gainesville, Florida, 32608, USA
| | - Anjali Patel
- University of Florida College of Medicine, Gainesville, Florida, 32608, USA
| | | | - Kevin Pierre
- University of Florida Department of Radiology, Gainesville, Florida, 32608, USA
| | - Brandon Lucke-Wold
- University of Florida Department of Neurosurgery, Gainesville, Florida, 32608, USA
| |
Collapse
|
2
|
Earl M, Abid S, Appleby I, Reddy U. Anesthesia for Endovascular Neurosurgery. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00451-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
3
|
Lefevre E, Robert T, Escalard S, Fahed R, Smajda S, Ciccio G, Desilles JP, Mazighi M, Blanc R, Piotin M. Presence of direct vertebrobasilar perforator feeders in posterior fossa arteriovenous malformations and association with poor outcomes after endovascular treatment. J Neurosurg 2019; 133:1802-1810. [PMID: 31703199 DOI: 10.3171/2019.8.jns191971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Treatment of posterior fossa arteriovenous malformations (PFAVMs) remains controversial as it is always challenging and may lead to major complications. Nonetheless, these lesions are more likely to bleed and generate poorer outcomes than other brain AVMs. The aim of this study was to evaluate the effect of endovascular treatment on long-term outcomes and identify the patient subgroups that might benefit from endovascular treatment. METHODS The authors performed a retrospective analysis of all consecutive cases of PFAVM managed at the Fondation Rothschild Hospital between 1995 and 2018. Clinical, imaging, and treatment data were prospectively gathered; these data were analyzed with respect to long-term outcomes. RESULTS Among the 1311 patients with brain AVMs, 114 (8.7%) had a PFAVM, and 88 (77.2%) of these patients had a history of bleeding. Of the 114 PFAVMs, 101 (88.6%) were treated (83 ruptured and 18 unruptured). The mean duration of follow-up was 47.6 months (range 0-240 months). Good neurological outcome at last follow-up was achieved in 79 cases (78.2%). Follow-up angiography showed obliteration of the PFAVM in 68.3% of treated cases. The presence of direct vertebrobasilar perforator feeders was associated with neurological deterioration (OR 5.63, 95% CI 11.15-30.76) and a lower obliteration rate (OR 15.69, 95% CI 2.52-304.03) after endovascular treatment. Other predictors of neurological deterioration and obliteration rate were consistent with the Spetzler-Martin grading system. CONCLUSIONS Advances in endovascular techniques have enabled higher obliteration rates in the treatment of PFAVMs, but complication rates are still high. Subgroups of patients who might benefit from treatment must be carefully selected and the presence of direct vertebrobasilar perforator feeders must call into question the indication for endovascular treatment.
Collapse
Affiliation(s)
- Etienne Lefevre
- 1Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France; and
| | - Thomas Robert
- 2Department of Neurosurgery, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ticino, Switzerland
| | - Simon Escalard
- 1Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France; and
| | - Robert Fahed
- 1Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France; and
| | - Stanislas Smajda
- 1Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France; and
| | - Gabriele Ciccio
- 1Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France; and
| | - Jean-Philippe Desilles
- 1Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France; and
| | - Mikael Mazighi
- 1Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France; and
| | - Raphaël Blanc
- 1Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France; and
| | - Michel Piotin
- 1Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France; and
| |
Collapse
|
4
|
Girdhar G, Read M, Sohn J, Shah C, Shrivastava S. In-vitro thrombogenicity assessment of polymer filament modified and native platinum embolic coils. J Neurol Sci 2014; 339:97-101. [DOI: 10.1016/j.jns.2014.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/28/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
|
5
|
Abstract
Acute ischemic stroke is recognized as the third leading cause of death in the United States; improved treatments for management are important to reduce disability and death. The standard of care of acute stroke therapy has been reperfusion/recanalization of the occluded vessels using pharmacologic management, endovascular management, or a combination approach. Significant improvements have been made in the management with the use of endovascular therapy. This article reviews the literature on the endovascular and neurosurgical management of patients presenting with acute ischemic stroke and presents current evidence-based guidelines for endovascular or neurosurgical interventions outlined for management of ischemic stroke.
Collapse
|
6
|
The natural history and treatment options for unruptured intracranial aneurysms. Int J Vasc Med 2012; 2012:898052. [PMID: 22500236 PMCID: PMC3303690 DOI: 10.1155/2012/898052] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 11/27/2011] [Accepted: 12/05/2011] [Indexed: 11/17/2022] Open
Abstract
Recent advances in angiographic technique have raised our awareness of the presence of unruptured intracranial aneurysms (UIAs). However, the appropriate management for these lesions remains controversial. To optimize patient outcomes, the physician must weigh aneurysmal rupture risk associated with observation against the complication risks associated with intervention. In the case that treatment is chosen, the two available options are surgical clipping and endovascular coiling. Our paper summarizes the current body of literature in regards to the natural history of UIAs, the evolution of the lesion if it progresses uninterrupted, as well as the safety and efficacy of both treatment options. The risks and benefits of treatment and conservative management need to be evaluated on an individual basis and are greatly effected by both patient-specific and aneurysm-specific factors, which are presented in this paper. Ultimately, this body of data has led to multiple sets of treatment guidelines, which we have summated and presented in this paper.
Collapse
|
7
|
Kim M, Shin Y. Reply:. AJNR Am J Neuroradiol 2012. [DOI: 10.3174/ajnr.a3024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
8
|
Samaniego EA, Dabus G, Linfante I. Stenting in the treatment of acute ischemic stroke: literature review. Front Neurol 2011; 2:76. [PMID: 22163225 PMCID: PMC3234448 DOI: 10.3389/fneur.2011.00076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 11/17/2011] [Indexed: 11/13/2022] Open
Abstract
Recanalization of acute large artery occlusions is a strong predictor of good outcome. The development of thrombectomy devices resulted in a significant improvement in recanalization rates compared to thrombolytics alone. However, clinical trials and registries with these thrombectomy devices in acute ischemic stroke (AIS) have shown recanalization rates in the range of 40-81%. The last decade has seen the development of nickel titanium self-expandable stents (SES). These stents, in contrast to balloon-mounted stents, allow better navigability and deployment in tortuous vessels and therefore are optimal for the cerebral circulation. SES were initially used for stent-assisted coil embolization of intracranial aneurysms and for treatment of intracranial stenosis. However, a few authors have recently reported feasibility of deployment of SES in AIS. The use of these devices yielded higher recanalization rates compared to traditional thrombectomy devices. Encouraged by these results, retrievable SES systems have been recently used in AIS. These devices offer the advantage of resheathing and retrieving of the stent even after full deployment. Some of these stents can also be detached in case permanent stent placement is needed. Retrievable SES are being used in Europe and currently tested in clinical trials in the United States. We review the recent literature in the use of stents for the treatment of AIS secondary to large vessel occlusion.
Collapse
Affiliation(s)
- Edgar A. Samaniego
- Interventional Neuroradiology and Endovascular Neurosurgery, Baptist Cardiac and Vascular InstituteMiami, FL, USA
| | - Guilherme Dabus
- Interventional Neuroradiology and Endovascular Neurosurgery, Baptist Cardiac and Vascular InstituteMiami, FL, USA
| | - Italo Linfante
- Interventional Neuroradiology and Endovascular Neurosurgery, Baptist Cardiac and Vascular InstituteMiami, FL, USA
| |
Collapse
|
9
|
Heller RS, Miele WR, Do-Dai DD, Malek AM. Crescent sign on magnetic resonance angiography revealing incomplete stent apposition: correlation with diffusion-weighted changes in stent-mediated coil embolization of aneurysms. J Neurosurg 2011; 115:624-32. [PMID: 21619405 DOI: 10.3171/2011.4.jns102050] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Few data are available on how closely stents appose the luminal vessel wall in stent-mediated coil embolization of intracranial aneurysms and on the effect of incomplete stent apposition on procedural thromboembolic complications.
Methods
Postprocedural 3-T MR diffusion-weighted imaging and time-of-flight angiography were obtained in 58 patients undergoing stent-mediated coil embolization of aneurysms using the Enterprise closed-cell and Neuroform open-cell self-expanding intracranial microstents.
Results
A distinctive semilunar signal pattern, identified using 3-T MR angiography, represented flow outside the confines of the stent struts in patients in whom Enterprise but not Neuroform devices were used. This pattern, designated as the crescent sign, was confirmed to correspond to incomplete stent apposition by use of high-resolution angiographic flat-panel CT scanning revealing flow ingress into and egress out of the isolated luminal wedge. The presence of the crescent sign was seen in 18 of 33 Enterprise-treated but in 0 of 25 Neuroform-treated cases, and was more likely in stents delivered in the tortuous internal carotid artery (p = 0.034). The crescent sign was strongly predictive of ipsilateral postprocedural lesions seen on diffusion-weighted imaging in the entire population (OR 18, 95% CI 4.33–74.8; p < 0.0001). In the Enterprise stent subset, ipsilateral lesions were detected on diffusion-weighted imaging in 15 (45%) of 33 cases; the crescent sign was seen in 12 (80%) of 15 patients with ipsilateral lesions on diffusion-weighted imaging, but in only 6 of 18 patients without lesions (OR 8, 95% CI 1.61–39.6; p = 0.006).
Conclusions
Incomplete stent apposition is detectable on 3-T MR angiography as a crescent sign, and was found to be highly prevalent in Enterprise closed-cell design stents used to assist coil embolization of aneurysms. Incomplete stent apposition was also associated with periprocedural ipsilateral hyperintense lesions on diffusion-weighted imaging. These results identify an association between incomplete stent apposition and thromboembolic complications in stent-mediated coil embolization of intracranial aneurysms.
Collapse
Affiliation(s)
- Robert S. Heller
- Cerebrovascular and Endovascular Division, Department of Neurosurgery,
- Tufts University School of Medicine, Boston, Massachusetts
| | - William R. Miele
- Cerebrovascular and Endovascular Division, Department of Neurosurgery,
- Tufts University School of Medicine, Boston, Massachusetts
| | - Daniel D. Do-Dai
- Department of Radiology, Tufts Medical Center; and
- Tufts University School of Medicine, Boston, Massachusetts
| | - Adel M. Malek
- Cerebrovascular and Endovascular Division, Department of Neurosurgery,
- Department of Radiology, Tufts Medical Center; and
- Tufts University School of Medicine, Boston, Massachusetts
| |
Collapse
|
10
|
White CJ, Abou-Chebl A, Cates CU, Levy EI, McMullan PW, Rocha-Singh K, Weinberger JM, Wholey MH. Stroke Intervention. J Am Coll Cardiol 2011; 58:101-16. [DOI: 10.1016/j.jacc.2011.02.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 02/07/2011] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
|
11
|
Treating the neurosurgical patient: beyond the pathology and technology. Can J Neurol Sci 2010; 38:1-2. [PMID: 21156418 DOI: 10.1017/s0317167100011008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
12
|
Erickson K, Cole D. Carotid artery disease: stenting vs endarterectomy. Br J Anaesth 2010; 105 Suppl 1:i34-49. [DOI: 10.1093/bja/aeq319] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
13
|
Patel NV, Gounis MJ, Wakhloo AK, Noordhoek N, Blijd J, Babic D, Takhtani D, Lee SK, Norbash A. Contrast-enhanced angiographic cone-beam CT of cerebrovascular stents: experimental optimization and clinical application. AJNR Am J Neuroradiol 2010; 32:137-44. [PMID: 20966059 DOI: 10.3174/ajnr.a2239] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE With modern imaging techniques, visualization of neurovascular stents remains challenging. We present a method for contrast-enhanced C-arm CBCT that provides detailed and simultaneous visualization of neurovascular stents and host arteries. MATERIALS AND METHODS CBCT was performed with a rotational angiography system by acquiring 620 projection frames over a 200° arc at 80 kVp and a total of 260 mAs. A superselective intra-arterial contrast injection protocol was optimized in swine experiments and implemented in 57 clinical examinations. High-resolution 3D reconstructions were evaluated by 3 blinded interventional neuroradiologists. Reviewers rated the images by answering questions related to both the quality of the stent and artery visualization and the clinical utility of the images. Raw agreement statistics, ICC, and κ statistics were computed for the questionnaire results. RESULTS Of 57 clinical evaluations, 5 were not evaluated due to the use of large balloon-mounted stents (n = 4) and a failed contrast injection (n = 1). In 50 of 52 evaluated examinations, the reviewers agreed that simultaneous stent and vessel visualization was of diagnostic quality. There was strong agreement that stent-vessel wall apposition could be assessed (κ = 0.79). CBCT detected contrast filling defects (κ = 0.85) and vascular calcification (κ = 0.68). Artifacts resulting from the aneurysm coil mass impaired the delineation of adjacent structures (κ = 0.72). CONCLUSIONS We have developed a technique that enables simultaneous clinically useful imaging of neurovascular stents and their host arteries that is unobtainable with other current imaging modalities. Further improvements are required to reduce artifacts from large coil masses due to x-ray scattering.
Collapse
Affiliation(s)
- N V Patel
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Gregory T, Appleby I. Anaesthesia for interventional neuroradiology. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2010. [DOI: 10.1016/j.mpaic.2010.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|