Hemorrhagic and Ischemic Stroke: Medical, Imaging, Surgical, and Interventional Approaches

 

A transdisciplinary approach to the medical, radiologic, interventional, and surgical treatment of stroke

In the last decade, advances in interventional, microsurgcial, radiosurgical techniques, medical approaches and imaging technology have dramatically changed the management of ischemic stroke. Perhaps the most important advance has been the increasing collaboration between multispecialty clinicians to deliver team-based stroke care. Hemorrhagic and Ischemic Stroke: Medical, Imaging, Surgical, and Interventional Approaches, Second Edition by renowned neurosurgeons Bernard R. Bendok and H. Hunt Batjer and acclaimed contributors provides a user-friendly, single resource for managing ischemic and hemorrhagic stroke. The second edition has been updated to reflect progress, most notably acute evaluation and triage, advanced imaging, critical care and medical support, and endovascular and surgical interventions. In addition to scientifically supported content, readers will benefit from pragmatic, real-world applications and concise, practical reviews.

Organized into four sections and 41 chapters, the text starts with the section Acute Triage, which includes early diagnosis and medical decision-making, advances in medical imaging, innovations in prehospital management of stroke, and the promise of telestroke networks. The second section, Critical Care, covers the importance of astute clinical examination, stabilization, and advanced neuromonitoring techniques. The third section, Open Surgical, Minimally Invasive, and Microsurgical Approaches, reviews recent surgical innovations that have the potential to be lifesaving and enhance quality of life in select patients. The fourth and final section, Neurointerventional Approaches, explores recent innovations in image-guided catheter techniques to deliver new therapies for stroke treatment and prevention.

Key Highlights:

The often difficult yet important adjudication of antithrombotic medication use

Insightful discussion of the importance of prehospital systems of care and stroke center certification

Insightful discussions of interventional and microsurgical approaches for hemorrhagic and ischemic stroke management

Medical illustrations and author-narrated videos provide a visual learning experience

Clinical pearls and case presentations enhance learning and retention of knowledge

The goal of this book is to increase collaborative stroke management among neuroradiologists, neurologists, neurosurgeons, neuroanesthesiolgists, neurologic critical care physicians, and allied health care professionals to achieve better patient outcomes.

 

Table of Contents:

 

Section I Acute Triage

1 Clinical Presentation and Acute Triage of Ischemic Stroke, Intracranial Hemorrhage, and Subarachnoid Hemorrhage

1.1 Clinical Case

1.2 Introduction

1.3 Acute Ischemic Stroke

1.3.1 Prehospital Setting

1.3.2 EMS Assessment and Management

1.3.3 Rapid Screening for Presence of Large Vessel Occlusion

1.3.4 Hospital Setting

1.3.5 Initial Stabilization

1.3.6 Clinical Examination

1.3.7 Determination of Thrombolysis Eligibility

1.3.8 Assessment of the Presence of LVO and Eligibility for Mechanical Thrombectomy

1.4 Intracranial Hemorrhage

1.4.1 Presentation

1.4.2 Prehospital Setting

1.4.3 Hospital Setting

1.5 Subarachnoid Hemorrhage

1.5.1 Presentation

1.6 Conclusions

1.7 Clinical Case Answers

1.8 References

2 Differential Diagnosis of Acute Ischemic and Hemorrhagic Stroke

2.1 Clinical Case

2.2 Introduction

2.3 Differential Diagnosis of Ischemic Strokes: Common Stroke Syndromes

2.4 Internal Carotid Artery Syndrome

2.4.1 Large Hemispheric Infarctions

2.4.2 Carotid Artery Dissection/Chronic ICA Occlusion/Hyperperfusion Syndromes

2.5 Anterior Cerebral Artery Syndrome

2.6 Middle Cerebral Artery Syndrome

2.7 Posterior Cerebral Artery Syndrome

2.8 Top of the Basilar Artery Syndrome and Brainstem Syndromes

2.9 Lacunar Strokes

2.10 Anterior Choroidal Artery Infarction

2.11 Behavioral Abnormalities Due to Acute Stroke

2.12 Intracerebral Hemorrhage

2.12.1 Hypertensive ICH

2.12.2 Cerebral Amyloid Angiopathy (CAA)

2.12.3 CNS Vascular Malformations

2.12.4 Medication-Induced Hemorrhage

2.13 Subarachnoid Hemorrhage

2.13.1 Aneurysmal SAH

2.13.2 Nonaneurysmal Perimesencephalic SAH

2.13.3 CNS Vascular Malformations

2.13.4 Cervicocephalic Arterial Dissection

2.13.5 Hematologic

2.14 Conclusion

2.15 Clinical Case Answers

2.16 References

2.17 Suggested Readings

3 Medical Imaging for Acute Ischemic and Hemorrhagic Stroke

3.1 Introduction

3.2 Imaging Modalities: Computed Tomography

3.2.1 Noncontrast Head CT

3.2.2 Computed Tomography Angiography

3.2.3 Computed Tomography Perfusion

3.3 Imaging Modalities: Magnetic Resonance Imaging

3.3.1 Diffusion-Weighted Imaging

3.3.2 Perfusion-Weighted Imaging

3.3.3 Magnetic Resonance Angiography

3.4 Summary

3.5 Clinical Case Answers

3.6 References

3.7 Suggested Readings

4 The Promise of Telestroke

4.1 Clinical Case

4.2 Introduction

4.3 Clinical Uses

4.3.1 Telestroke in the Emergency Department Setting

4.3.2 Telestroke in Settings Spanning the Continuum of Stroke Care

4.3.3 Telestroke in Clinical Research

4.3.4 Telestroke in Education

4.4 Technological Considerations

4.5 Telestroke Quality and Outcome Metrics

4.6 Telestroke Network Operational Considerations

4.6.1 Potential Obstacles

4.6.2 Health Economic Evaluations of Telestroke

4.7 Comprehensive Virtual Stroke Centers of the Future

4.8 Clinical Case Answers

4.9 References

4.10 Suggested Readings

5 Innovations in Prehospital Management of Stroke

5.1 Clinical Case

5.2 Emergency Medical System and Stroke Systems of Care

5.2.1 EMS Notification by the General Population

5.2.2 EMS Role in Stroke Triage

5.2.3 EMS Stroke Assessment: Prehospital Scales

5.2.4 Triage and Transport to the Target Stroke Center

5.2.5 Concept of the “Golden Hour”

5.3 The Mobile Stroke Unit

5.3.1 Mobile Stroke Ambulance: Ground and Air

5.3.2 Prehospital Brain Imaging

5.3.3 Prehospital Laboratory and Pharmacy

5.3.4 Cost-Effectiveness

5.4 Prehospital Stroke Management

5.4.1 Telemedicine in Prehospital Stroke Evaluation

5.4.2 Treatment of Acute Ischemic Stroke

5.4.3 Treatment of Hemorrhagic Stroke

5.4.4 Neuroprotection and Clinical Research in Prehospital Setting

5.5 Future Directions

5.6 Conclusion

5.7 Clinical Case Answers

5.8 Acknowledgements

5.9 References

5.10 Suggested Readings

6 Intravenous Fibrinolysis for Acute Ischemic Stroke

6.1 Clinical Case 1

6.2 Fibrinolysis

6.3 Fibrinolytic Drugs Studied for the Treatment of Acute Ischemic Stroke

6.4 History of Fibrinolysis Treatment for Acute Cerebral Ischemia

6.4.1 Clinical Case 2

6.4.2 Case Management Issues

6.5 Initial Restrictions for Administration of Intravenous Fibrinolytic Medication

6.5.1 Clinical Case 3

6.6 Increasing Utilization of Fibrinolysis for Treating Acute Ischemic Stroke Patients

6.6.1 Clinical Case 4

6.7 Revising Original Indications for the Use of Fibrinolytic Medication

6.7.1 Time from Stroke Onset, or Last Known to be at Usual Baseline

6.7.2 Age and Baseline Stroke Severity

6.7.3 Rapidly Improving Neurological Deficits

6.7.4 Use of Anticoagulation Medication

6.7.5 Mild, Nondisabling, Symptoms at Presentation

6.7.6 Patients without Capacity to Provide Consent to Treatment

6.7.7 Early Ischemic Changes on CT Imaging

6.7.8 Other Conditions Previously Considered by Some to be Too Risky for “Off-Label” Use of tPA

6.8 Clinical Situations where there is Considerable Uncertainty About Administering tPA to an Acute Ischemic Stroke Patient

6.9 Utilization of Telemedicine to Increase Use of Fibrinolytic Medication in the Treatment of Acute Ischemic Stroke

6.9.1 Clinical Case 5

6.10 Other Factors Impacting tPA Utilization Rates

6.10.1 Stroke Systems of Care

6.10.2 Teaching Hospitals

6.11 Future Strategies to Increase Utilization of Fibrinolysis for the Treatment of Acute Ischemic Stroke

6.12 Conclusion

6.13 Clinical Case 1 Answers

6.14 References

7 Identifying Patients for Stroke Thrombectomy

7.1 Clinical Case

7.2 Questions

7.3 Introduction

7.4 AHA/ASA 2019 Guidelines

7.5 Technical Details

7.6 Low ASPECTS Trials

7.7 Medium and Distal Occlusions

7.8 Intracranial Atherosclerotic Disease

7.9 Tandem Occlusion

7.10 Posterior Circulation Stroke

7.10.1 Basilar Artery Occlusion

7.10.2 Posterior Cerebral Artery Occlusion

7.11 Special Situations

7.11.1 Low National Institutes of Health Stroke Scale Score

7.11.2 Poor Baseline Modified Rankin Scale

7.11.3 Cancer

7.12 Future Directions

7.13 References

8 Stroke Center Certification

8.1 Clinical Case

8.2 Stroke Accreditation

8.2.1 Joint Commission Certification Process

8.2.2 Level 2 Acute Stroke Ready Hospital

8.2.3 Primary Stroke Center

8.2.4 Thrombectomy Capable

8.2.5 Comprehensive Stroke Center

8.3 Organization 2: Healthcare Facilities Accreditation Program

8.4 Organization 3: DNV GL

8.5 Clinical Case Answers

8.6 References

8.7 Suggested Readings

Section II Critical Care

9 Critical Care Management of Acute Ischemic Stroke

9.1 Clinical Case

9.2 Introduction

9.3 Critical Care after Acute Ischemic Stroke

9.3.1 Airway and Ventilation Management

9.3.2 Blood Pressure Monitoring and Goals

9.3.3 Antiplatelets, Systemic Anticoagulation, and Statin Therapy Initiation

9.3.4 Point-of-Care Ultrasound and Cardiac Telemetry

9.3.5 Neuromonitoring Modalities

9.4 Common Neurocritical Care Complications

9.4.1 Angioedema after IV tPA

9.4.2 Symptomatic Intracranial Hemorrhage

9.4.3 Malignant Cerebral Edema

9.4.4 Seizures

9.4.5 Other Complications

9.5 Conclusion

9.6 Clinical Case Answers

9.7 References

9.8 Suggested Reading

10 New Horizons for Hemorrhagic Stroke Critical Care Management

10.1 Clinical Case 1

10.2 Introduction

10.3 Etiology/Risk Factors

10.4 Medical Management

10.5 Clinical Severity Assessment

10.6 Emergency Department Management

10.7 The Importance of Intensive Medical Therapies

10.7.1 Fever

10.7.2 Hyperglycemia

10.7.3 Hypertension

10.7.4 Deep Veins Thrombosis

10.7.5 Steroids

10.7.6 Anticonvulsants

10.7.7 Cerebral Edema

10.7.8 Hydrocephalus and Intraventricular Hemorrhage

10.7.9 Anticoagulant-Related Intracranial Hemorrhage

10.8 Clinical Case 2

10.8.1 Heparin and Low-Molecular-Weight Heparins

10.8.2 Antiplatelet Agents

10.8.3 Factor Xa Inhibitors

10.8.4 Direct Thrombin Inhibitor

10.9 Resuming Anticoagulation Therapy after Intracerebral Hemorrhage

10.9.1 Outcome Predictions and Withdrawal of Life-Sustaining Treatments

10.10 Conclusion

10.11 Clinical Case Answers

10.12 References

10.13 Suggested Readings

11 Critical Care Management of Subarachnoid Hemorrhage and Vasospasm

11.1 Clinical Case

11.2 Introduction

11.3 Grading of Subarachnoid Hemorrhage

11.4 Diagnostic Challenges

11.5 Initial Stabilization

11.6 Common Complications

11.7 Seizures

11.8 Blood Pressure

11.9 Hydrocephalus

11.10 Rebleeding

11.11 Hyponatremia

11.12 Cardiac Arrhythmias and Cardiomyopathy

11.13 Glucose

11.14 Fever

11.15 Deep Vein Thrombosis

11.16 Vasospasm and Delayed Cerebral Ischemia

11.17 Prevention of Vasospasm

11.18 Detection of Vasospasm

11.19 Treatment of Vasospasm

11.20 Conclusion

11.21 References

11.22 Suggested Readings

12 Management of Anticoagulation and Antiplatelets in Hemorrhagic Stroke: Administration and Reversal

12.1 Clinical Case

12.1.1 Questions

12.2 Introduction

12.2.1 Pharmacology and Reversal of Antiplatelets

12.2.2 Pharmacology and Reversal of Anticoagulants

12.2.3 Challenges of Antiplatelets/Anticoagulants in SAH and ICH

12.3 Clinical Cases

12.3.1 Intracerebral Hemorrhage with a Mechanical Cardiac Valve

12.3.2 Acute Stenting with MCA Infarct

12.3.3 Atrial Fibrillation with Hemorrhagic Conversion of Infarct

12.4 Conclusion

12.5 Clinical Case Answers

12.6 References

13 Medical Management of Ischemic Stroke and Prevention

13.1 Clinical Case

13.2 General Medical Management

13.2.1 Initial Acute Management

13.2.2 Blood Pressure, Temperature, and Blood Glucose Management

13.2.3 Antiplatelet Treatment

13.2.4 Additional Screening and Prophylaxis

13.2.5 Stroke Mimics

13.2.6 Subsequent Workup and Monitoring

13.3 Etiology-Specific Management

13.3.1 Large Artery Atherosclerosis

13.3.2 Cardioembolic

13.3.3 Small Vessel Occlusion

13.3.4 Other Determined Causes of Ischemic Stroke

13.3.5 Cryptogenic

13.4 Secondary Prevention

13.5 Clinical Case Answers

13.6 References

13.7 Suggested Readings

14 Prognostication, Ethics, and Scales

14.1 Clinical Case

14.2 Prognostication in Stroke

14.3 Methods of Prognostication

14.4 Clinical Grading Scales

14.4.1 Ischemic Stroke

14.4.2 Intracerebral Hemorrhage

14.4.3 Subarachnoid Hemorrhage

14.5 Neuroimaging

14.6 Electrophysiology

14.7 Providing a Prognosis

14.8 Ethics

14.9 Clinical Case Answers

14.10 References

14.11 Links to Relevant Guidelines

14.12 Suggested Readings

15 Advanced Neuromonitoring in Acute Brain Injury

15.1 Clinical Case

15.2 Introduction

15.3 Placement of Brain Probes

15.4 Physiologic Principles

15.4.1 Intracranial Pressure and Monitoring

15.4.2 Brain Tissue Oxygen Monitoring

15.5 Neuroelectrophysiology

15.5.1 Electroencephalogram, Quantitative EEG, and Bispectral Index

15.5.2 Somatosensory Evoked Potentials

15.6 Case Presentation

15.7 Clinical Case Answers and Discussion

15.7.1 Highlights

15.8 References

15.9 Suggested Readings

16 Transcranial Doppler in the Intensive Care Unit

16.1 Clinical Case

16.2 Introduction

16.3 Physics

16.4 Traumatic Brain Injury

16.5 Subarachnoid Hemorrhage

16.6 Stroke

16.7 Brain Death Determination

16.8 Other Applications

16.9 Case Summary Discussion

16.10 References

16.11 Suggested Readings

17 Brain Death

17.1 Clinical Case 1

17.2 Brain Death: An Evolving Concept

17.3 Clinical Criteria

17.3.1 Prerequisites

17.3.2 Neurological Examination

17.4 Ancillary Testing

17.4.1 Electrophysiologic Tests

17.4.2 Neuroimaging

17.5 Clinical Case 2

17.6 Diagnosis of Brain Death in Pediatrics

17.7 Family Discussion

17.8 Physiologic Response to Brain Death and Organ Procurement

17.9 Clinical Case Answers

17.9.1 Case 1

17.9.2 Case 2

17.10 References

17.11 Suggested Further Readings

Section III Open Surgical, Minimally Invasive and Microsurgical Approaches

18 Anesthesia Considerations for Neurovascular Procedures

18.1 Clinical Case

18.2 Introduction

18.3 Preoperative Management

18.4 Intraoperative Management

18.4.1 Hemodynamic Management

18.4.2 Brain Bulk Management

18.4.3 Cerebral Protection

18.5 Anesthesia Considerations for Carotid Surgery

18.6 Anesthesia for Endovascular Treatment of Acute Ischemic Stroke

18.7 Postoperative Care

18.7.1 Systemic Hypertension on Emergence

18.7.2 Intracranial Hypertension on Emergence

18.8 Conclusion

18.9 Clinical Case Answers

18.10 References

18.11 Suggested Readings

19 Bypass for Acute and Chronic Ischemic States

19.1 Clinical Case

19.2 Introduction and Background

19.3 Patient Selection and Indications for Bypass Surgery

19.3.1 Diagnostic Workup

19.3.2 Indication

19.4 Treatment

19.4.1 Direct versus Indirect

19.5 Technique

19.5.1 Pre-, Peri-, and Postoperative Considerations

19.5.2 How We Do It: Combined Direct STA-MCA Anastomosis and EDAS

19.5.3 Vein Interposition

19.6 Clinical Case Answers

19.7 References

19.8 Suggested Readings

20 Moyamoya Disease

20.1 Clinical Case

20.2 Description

20.3 Epidemiology

20.4 Natural History

20.4.1 Adult Moyamoya Disease

20.4.2 Pediatric Moyamoya Disease

20.5 Radiographic Findings

20.6 Genetics

20.7 Treatment Options

20.7.1 Expectant

20.7.2 Medical

20.7.3 Surgical

20.8 Surgical Techniques

20.8.1 Direct Revascularization

20.8.2 Indirect Revascularization

20.9 Outcomes

20.10 Clinical Case Answers

20.11 References

20.12 Suggested Readings

21 Carotid Endarterectomy

21.1 Clinical Case

21.2 Natural History and Pathophysiology

21.3 History of Carotid Endarterectomy

21.4 Technique

21.4.1 Preparation

21.4.2 Positioning

21.4.3 Exposure

21.4.4 Vessel Occlusion

21.4.5 Plaque Removal

21.4.6 Shunt

21.4.7 Closure

21.4.8 Postoperative Care

21.5 Complications

21.5.1 Ischemia

21.5.2 Hemorrhage

21.5.3 Other

21.6 Patient Selection

21.6.1 Symptomatic Carotid Stenosis

21.6.2 Asymptomatic Carotid Stenosis

21.7 Clinical Case Answers

21.8 References

21.9 Suggested Readings

22 Microsurgical Revascularization of Extracranial Vertebral Artery Disease

22.1 Introduction

22.2 Anatomy

22.3 Clinical Manifestations

22.4 Indications for Treatment

22.5 Symptomatic Patients

22.6 Asymptomatic Patients

22.7 Microsurgical Revascularization of the Extracranial Artery

22.8 Surgical Technique for Proximal Vertebral Artery Revascularization

22.9 Microsurgical Revascularization versus Angioplasty and Stenting of the Proximal Vertebral Artery

22.10 Surgical Technique for Microsurgical Decompression of V2 Segment

22.11 Microsurgical Treatment of V3 Compression

22.12 Conclusion

22.13 References

23 Microsurgery for Unruptured Aneurysms

23.1 Clinical Case

23.2 Introduction

23.3 Diagnosis

23.3.1 Imaging Workup

23.3.2 Predictors of Rupture

23.3.3 Screening

23.3.4 Effect on Quality of Life and Other Considerations

23.4 Treatment Decision-Making

23.4.1 Risk of Treatment

23.4.2 International Study of Unruptured Intracranial Aneurysms

23.4.3 Unruptured Intracranial Aneurysm Treatment Score

23.4.4 Southwestern Aneurysm Severity Index

23.5 Treatment Options

23.6 Microsurgery Techniques

23.6.1 Mycotic Aneurysms

23.6.2 Mirror Aneurysms

23.7 Conclusion

23.8 Clinical Case Discussion

23.9 References

24 Microsurgery for Ruptured Aneurysms

24.1 Clinical Case

24.2 Introduction, Epidemiology, and Patient Selection

24.3 Pre- and Postoperative Management

24.4 Preoperative Imaging

24.5 Surgical Technique

24.5.1 Exposure

24.5.2 Temporary Clipping

24.5.3 Permanent Clip Selection

24.5.4 Anatomic Nuances: Anterior Circulation

24.5.5 Anatomic Nuances: Posterior Circulation Aneurysms

24.5.6 Other Anatomic Subtypes

24.6 Complication Avoidance and Management

24.6.1 Managing Intraoperative Rupture

24.6.2 Specific Anatomical Considerations

24.6.3 Conclusion

24.7 Clinical Case Answers

24.8 References

24.9 Suggested Readings

25 Microsurgery for Intracranial Arteriovenous Malformations

25.1 Clinical Case

25.2 Introduction

25.3 Epidemiology and Natural History

25.4 Evaluation of Arteriovenous Malformation

25.5 Grading of Arteriovenous Malformation

25.6 Decision-Making

25.7 Role of Preoperative Embolization

25.8 Microsurgery

25.9 Postoperative Management

25.10 Microsurgical Considerations at Specific Critical Locations

25.11 Surgical Complications and Management

25.12 Surgical Outcome

25.13 Future Directions

25.14 Clinical Case Answers

25.15 References

26 Microsurgery of Cavernous Malformations

26.1 Angioma Alliance 2017 Guidelines ▶ [615]

26.2 Clinical Case

26.3 Introduction

26.4 Radiographic Presentation

26.5 Surgical Indications

26.6 Microsurgical Techniques and Approaches

26.7 Microsurgical Technique

26.8 Surgical Approaches

26.8.1 Supracerebellar-Infratentorial Approach

26.8.2 Retrosigmoid Approach

26.8.3 Far-Lateral Approach

26.8.4 Interhemispheric Transcallosal Approach

26.9 Clinical Outcomes of Surgical Resection

26.10 Conclusion

26.11 Clinical Case Answers

26.12 References

26.13 Suggested Readings

27 Surgery for Intracranial Dural Arteriovenous Fistulas

27.1 Clinical Case

27.2 Introduction and Epidemiology

27.3 Proposed Pathogenesis

27.4 Presentation

27.5 Classification Schema

27.6 Imaging

27.7 Patient Selection and Treatment

27.7.1 Supratentorial

27.7.2 Infratentorial

27.8 Combined Surgical/Endovascular Treatment

27.9 Summary

27.10 Clinical Case Answers

27.11 References

27.12 Suggested Readings

28 Open Surgery and Craniectomy for Malignant Stroke and ICH

28.1 Clinical Case

28.2 Introduction

28.3 Craniectomy for Malignant Ischemic Stroke

28.3.1 Evidence on Craniectomy for Malignant Edema in Acute Ischemic Stroke

28.3.2 Guidelines

28.3.3 Surgical Technique

28.4 Open Surgery for Intracranial Hemorrhage

28.4.1 Intracranial Hemorrhage Clot Evacuation

28.4.2 Role of Craniectomy in Intracerebral Hemorrhage

28.4.3 Timing of Surgery

28.4.4 Guidelines

28.5 Cranioplasty

28.5.1 Stroke-Specific Studies

28.5.2 Large-Scale Studies

28.6 Conclusions

28.7 Clinical Case Answers

28.8 References

29 Minimally Invasive Approaches for Intracerebral Hemorrhage and Intraventricular Hemorrhage

29.1 Clinical Case

29.2 Introduction

29.3 Pathogenesis and Outcome Determinants

29.4 Acute Resuscitation and Medical Management

29.5 Blood Pressure Control

29.6 Reversal of Coagulopathy

29.7 Intracranial Pressure Management

29.8 Surgical Management

29.8.1 Open Craniotomy

29.8.2 Rationale for Minimally Invasive Procedures

29.9 Intracerebral Hemorrhage and MISTIE

29.9.1 Introduction

29.9.2 Clot Stability and Etiology Screening

29.9.3 Catheter Trajectories

29.9.4 Cannula Aspiration and Catheter Placement for Thrombolysis

29.9.5 Outcomes

29.9.6 Lesions Learned

29.10 Intraventricular Hemorrhage and CLEAR

29.10.1 Introduction

29.10.2 Rationale

29.10.3 CLEAR IVH and CLEAR III

29.10.4 Clot Stability and Etiology Screening

29.10.5 Catheter Placement

29.10.6 Lessons Learned

29.11 Other Trials

29.12 Conclusion

29.13 Clinical Case Answers

29.14 References

29.15 Suggested Readings

30 Radiosurgical Management of Arteriovenous Malformations

30.1 Clinical Case

30.2 Introduction

30.3 The Value of Stereotactic Radiosurgery

30.4 Limitations of Radiosurgery

30.5 How Does Radiosurgery Work?

30.6 Clinical Experience

30.7 How AVM Obliteration Affects Decision-Making

30.8 Timing

30.9 Radiosurgery Morbidity and Decision-Making

30.10 Options for Large AVMs: Staged Volume Radiosurgery and Embolization

30.11 Embolization and SRS

30.12 Radiosurgery First, then Embolization

30.13 Radiosurgery for Dural Arteriovenous Fistulas

30.14 Conclusion

30.15 Clinical Case Answers

30.16 References

Section IV Neurointerventional Approaches

31 Endovascular Thrombectomy: Revolution in the Care of Acute Ischemic Stroke

31.1 Clinical Case

31.2 Introduction

31.3 Intra-arterial Thrombolysis

31.4 PROACT I

31.5 PROACT II

31.6 Intra-arterial Thrombolysis in the Posterior Circulation

31.7 Mechanical Thrombectomy

31.8 Patient Selection

31.9 Devices, Techniques, and Clot Types

31.10 Anesthesia

31.11 Complications Management

31.12 Future Directions

31.13 Clinical Case Answers

31.14 References

31.15 Suggested Readings

32 Intracranial Atherosclerotic Disease

32.1 Clinical Case

32.2 Introduction

32.3 Epidemiology

32.4 Natural History

32.5 Clinical and Radiographic Evaluation

32.6 Treatment Options

32.6.1 Medical Management

32.6.2 Endovascular Management

32.6.3 Management of ICAD Underlying a Large-Vessel Occlusion

32.6.4 Outcomes

32.6.5 Surgical Management

32.7 Conclusion

32.8 Clinical Case Answers

32.9 References

32.10 Suggested Readings

33 Endovascular Stenting in Atherosclerotic Carotid Artery Stenosis

33.1 Clinical Case

33.2 Pathogenesis

33.3 Modes of Presentation

33.4 Diagnostic Tests

33.4.1 Calculating the Degree of Stenosis

33.4.2 Carotid Duplex Ultrasonography

33.4.3 Magnetic Resonance Angiography

33.4.4 Computed Tomography Angiography

33.4.5 Digital Subtraction Angiography

33.5 Natural History

33.6 Medical Management

33.7 Carotid Endarterectomy

33.8 Carotid Artery Stenting

33.9 Treatment Selection

33.10 Contraindications for Carotid Artery Stenting

33.11 Carotid Artery Stenting Technique

33.11.1 Stages of Carotid Artery Stenting

33.12 Stent Options

33.13 Embolic Protection Devices

33.14 Complications

33.15 Clinical and Radiographic Follow-up

33.16 Conclusion

33.17 Clinical Case Answers

33.18 References

33.19 Suggested Readings

34 Management of Vertebral Artery Origin Stenosis

34.1 Clinical Case 1

34.2 Introduction

34.3 Epidemiology

34.4 Risk Factors

34.5 Natural History

34.6 Presentation

34.7 Imaging

34.7.1 Noninvasive Vessel Imaging

34.7.2 Perfusion Imaging

34.7.3 Catheter Angiography

34.8 Medical Treatment of Vertebral Origin Stenosis

34.8.1 Blood Pressure Management

34.8.2 Statin Therapy

34.9 Revascularization Procedures

34.9.1 Surgical Revascularization

34.10 Endovascular Treatment of Vertebral Artery Origin Stenosis

34.10.1 General Patient Preparation

34.10.2 Anti-Aggregation

34.10.3 Anticoagulation

34.10.4 Anesthesia

34.10.5 Access

34.10.6 Measurements

34.10.7 Distal Embolic Protection

34.10.8 Stenting Strategies

34.11 Clinical Case 1 (Continued)

34.11.1 Technique

34.11.2 Self-expanding Intracranial Stents

34.12 Clinical Case 2

34.12.1 Clinical History

34.12.2 Technique

34.13 Stenting from the Vertebral Artery into the Subclavian Artery

34.14 Conclusion

34.15 Clinical Case Answers

34.16 References

34.17 Suggested Reading

35 Aneurysm Coiling

35.1 Clinical Case

35.2 Introduction

35.3 Aneurysm Coiling

35.4 Adjuncts to Coiling

35.4.1 Balloon-Assisted Coiling

35.4.2 Stent-Assisted Coiling

35.4.3 Adjunct Device-Assisted Coiling

35.5 Patient Selection

35.5.1 Unruptured Aneurysms

35.5.2 Ruptured Aneurysms

35.6 Coiling versus Clipping

35.7 Conclusion

35.8 Clinical Clinical Case Answers and Discussion

35.9 References

36 Vasospasm Management

36.1 Clinical Case

36.2 Introduction

36.3 Epidemiology

36.4 Pathophysiology

36.5 Clinical Presentation and Symptoms

36.6 Diagnosis

36.7 Vasospasm Prophylaxis

36.8 Vasospasm Medical Management

36.9 Vasospasm Endovascular Management

36.9.1 Timing of Endovascular Management

36.9.2 Types of Endovascular Intervention

36.9.3 Chemical Angioplasty (Intra-arterial Vasodilator Therapy)

36.9.4 Mechanical Angioplasty

36.9.5 Balloon Angioplasty

36.9.6 Stent Angioplasty

36.10 Role of Prophylactic Angioplasty

36.11 Experimental Therapies

36.12 Clinical Case Answers and Discussion

36.13 References

37 Flow Diversion

37.1 Clinical Case 1

37.1.1 Flow Diversion for a Communicating Segment Internal Carotid Artery Aneurysm Using Coils and Pipeline Flex

37.2 Introduction to Flow Diversion

37.3 Current Indications and Clinical Use

37.4 Safety and Efficacy

37.5 Devices: Design, Current Availability, and Technique

37.5.1 Pipeline Embolization Device

37.5.2 Silk Flow Diverter

37.5.3 SURPASS

37.5.4 Flow Re-direction Endoluminal Device

37.5.5 p64 Flow Modulation Device

37.5.6 Bravo

37.6 Special Considerations

37.6.1 Posterior Circulation Aneurysms

37.6.2 Distal Aneurysms

37.6.3 Ruptured Aneurysms

37.6.4 Blister Aneurysms

37.6.5 Giant Aneurysms

37.6.6 Carotid Cavernous Fistula

37.7 Antiplatelet Therapy

37.7.1 Platelet Function Testing and Alternative Regimens

37.8 Clinical Case 2

37.8.1 Flow Diversion for a Blister Type Dorsal Wall Internal Carotid Artery Aneurysm Using Multiple Pipeline Flex Devices

37.9 Clinical Case 1 Answers

37.10 Clinical Case 2 Answer

37.11 References

37.12 Suggested Readings

38 Approaches to Extracranial and Intracranial Dissection

38.1 Clinical Case 1

38.2 Pathophysiology and Natural History

38.3 Imaging of Cervical and Vertebral Artery Dissections

38.4 The Cervical Artery Dissection in Ischemic Stroke Patients Study Group: Medical Management of Dissections

38.5 Surgical Intervention and the Management of Dissections

38.6 Ischemic Presentation of Dissection and Surgical Intervention

38.7 Clinical Cases

38.8 Posterior Circulation Dissections and Surgical Treatment Options

38.9 Pseudoaneurysms and Subarachnoid Hemorrhage

38.10 Clinical Case

38.11 Technical Nuances of Endovascular Stenting, Stent-Assisted Coiling, and Flow Diversion

38.12 Conclusion

38.13 Clinical Case Answers and Discussion

38.14 References

39 Endovascular Management of Arteriovenous Malformations

39.1 Clinical Case

39.2 Historical Perspective

39.3 Pathophysiology

39.4 Epidemiology

39.5 Presenting Symptoms and Natural History

39.6 Anatomy and Classification

39.7 ARUBA Trial

39.8 Indications and Strategies for Endovascular Treatment

39.8.1 Preoperative Embolization

39.8.2 Pre- and Postradiosurgery Embolization

39.8.3 Stand-Alone Treatment

39.9 Technical Considerations and Complication Avoidance Embolic Agents

39.10 Microcatheters

39.11 Advanced Angiographic Techniques

39.11.1 Transvenous Approach

39.11.2 Double Arterial Catheterization

39.11.3 Balloon-Assisted Embolization

39.12 Complication Avoidance

39.13 Conclusion

39.14 Clinical Case Answers

39.15 References

40 Endovascular Approaches to Intracranial Dural Arteriovenous Fistulas

40.1 Clinical Case 1

40.2 Introduction

40.3 Pathogenesis

40.4 Presentation

40.5 Natural History

40.6 Anatomic Considerations

40.7 Intracranial Venous Anatomy

40.7.1 Deep Venous Drainage

40.7.2 Cortical Venous Drainage

40.7.3 Sinus Drainage

40.8 Arterial Supply of the Dura

40.8.1 Arterial Anastomoses

40.9 Imaging

40.9.1 Computed Tomography

40.9.2 Magnetic Resonance Imaging

40.9.3 Digital Subtraction Angiography

40.10 Grading

40.11 Patient Selection

40.12 Endovascular Embolization

40.12.1 Transarterial Embolization

40.13 Clinical Case 2

40.13.1 Transvenous Embolization

40.13.2 Transfemoral Venous Access

40.13.3 Head and Neck Direct Venous Access

40.14 Clinical Case 3

40.14.1 Outcome

40.15 Conclusion

40.16 Clinical Case 1 Answers

40.17 References

40.18 Suggested Readings

41 Venous Thrombectomy

41.1 Clinical Case

41.2 Introduction

41.3 Epidemiology and Pathogenesis

41.4 Pathophysiology

41.5 Clinical Presentation

41.6 Diagnosis

41.6.1 Laboratory Tests

41.6.2 Computed Tomography and Computed Tomography Venogram

41.6.3 Magnetic Resonance Imaging and Magnetic Resonance Venogram

41.6.4 Catheter Angiography

41.7 Treatment

41.7.1 Systemic Anticoagulation

41.7.2 Endovascular Intervention

41.7.3 Rheolytic Thrombectomy

41.7.4 Clot Aspiration System

41.7.5 Merci Clot Retriever with Microsnare

41.7.6 Balloon Extraction

41.7.7 Stent Retrievers

41.8 Outcome

41.9 Medical or Surgical Management of Secondary Complications

41.9.1 Seizure

41.9.2 Hydrocephalus

41.9.3 Intracranial Hypertension

41.9.4 Visual Loss

41.9.5 Arteriovenous Fistula

41.10 Conclusions

41.11 Clinical Case Answers

41.12 References

41.13 Suggested Readings

Contributors

Index

Imprint/Access Code

 

 

An aparitie	06.11.2024
Autor	Bernard Bendok, H. Batjer
Dimensiuni	279 x 216 mm
Editura	Thieme
Format	Hardcover
ISBN	9781684200436
Limba	Engleza
Nr pag	484
Versiune digitala	DA