1 / 18

Advances in Interventional Neuroradiology

Advances in Interventional Neuroradiology. Dr James F Peerless March 2014. Introduction. Interventional Radiology. Endovascular, catheter-based techniques using fluoroscopy and angiography To diagnose and treat vascular diseases of the CNS Examples diagnostic cerebral angiography

carlow
Download Presentation

Advances in Interventional Neuroradiology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Advances in Interventional Neuroradiology Dr James F Peerless March 2014

  2. Introduction

  3. Interventional Radiology • Endovascular, catheter-based techniques using fluoroscopy and angiography • To diagnose and treat vascular diseases of the CNS • Examples • diagnostic cerebral angiography • acute endovascular stroke treatment • revascularization of carotid and intracranial stenosis • cerebral aneurysm

  4. The Past

  5. From Small Beginnings • Catheterisation of arterial cerebral vessels first described in 1931 by French neurologist, Dr Moniz. • Access limited by size of catheters • Transfemoral and transcarotid approaches • Treatment options: • Electrothrombosis (1964) • Detachable balloons (1970) • Injection into aneurysm • Iron • Microspheres • Microcatheter developed in 1988 • Allowed direct probing of aneurysms

  6. Coil Development • Free coil occlusion • Detachable coils via a delivery wire • Separated with direct current • Guido Gugliemi (UCLA), 1991 • Initially used in non-ruptured posterior aneurysms, poor grade SAH and those unfit for surgery • Now the treatment of choice, >90% • Electrolysis detachment replaced by mechanical/pressure devices

  7. Coil Development

  8. The Present

  9. Aneurysms • Coiling • Bare platinum coils • Bioactive PGA coils • Increased thrombogeneity and fibrosing induction • Stenting • Balloon-remodelling and embolisation • Flow-diverters • devices are designed to achieve aneurysm occlusion through reconstruction of the diseased segment of artery

  10. Aneurysm Treatments

  11. Balloon and Onyx Embolisation

  12. Collected data in 2143 patients between 1994-2002 • Clipped: 1070 (30.6 %) • Coiled: 1073 (23.7 %) • Follow-up series in 2005 + 2009 conferred a survival benefit of at least seven years • Increased (small) risk of rebleed • Future bleeds “essentially eliminated”

  13. Previous small single-centre trials showed promise of bioactive coils • Bare platinum versus Cerecyte coils • RCT (non-blinded), n = 500 • Non-significance demonstrated, but • Increased periprocedural M&M • Poorer 6-month outcome (mRS)

  14. ATENA Trial, 2010 • Data collected in 622 patients in France and Canada between 2005 & 2006 • Coiling and remodelling associated with better radiological outcomes than stenting • Factors for a favourable outcome • Age < 65 • Aneurysm diameter < 6 mm • Dome-neck ratio > 1.5

  15. Brain AVMs • Embolisation techniques • nBCA • n-butyl-cyano-acrylate • Onyx licensed in 2005 • polymer in organic solvent • Results from single-centre studies only • Trade-off between long- and short-term gain • Pierot et al., 2009 (J. Neuroradiol.) • >60% occlusion rates in 73% on 116 patients • 2% mortality, 8% morbidity at one month • Increased risk of recanalisation with reduced occlusion • Periprocedural morbidity • 12.2%: Hauck et al., 2009 (Am. J Neuroradiol.) • 19.5%: Panagiotopolous et al., 2009 (Am. J Neuroradiol.)

  16. The Future

  17. Future Advances • Aneurysms • Problems are the same as in the past • Tricky aneurysms are large with wide necks • Difficult to treat with high recurrence rates • flow diverters • Bettering the understanding of: • aneurysm formation, growth, and rupture • AVMs • New embolisation materials

  18. Reference • Schumacher M, Weber J. Aneurysm Treatment – a Neuroradiologic Success Story. Clinical Neuroradiology, 2008;4:203-215 • Gounis J, De Leo III M, Wakhloo A. Advances in Interventional Neuroradiology. Stroke, 2010;41:e81-e87 • Chen M. Interventional Neurology – Recent Advances & New Applications. US Neurology, 2011;7(1):37-40

More Related