STROKE AND INTERVENTIONAL NEUROLOGY

Emerging trends............

INTRODUCTION

Stroke is generally divided into two subgroups:

1- Ischaemic Stroke (due to blockage of the artery of the brain by a clot or an atherocslerotic plaque)

2- Haemorrhagic Stroke (due to rupture of the brain arteries which may be due to brain aneurysm, AVM etc.)

In the recent past there has been significant advancement in the management of stroke. Development of Interventional Neurology (also know as Interventional Neuroradiology or Endovascular Neurosurgery or Neuroendovascular therapy) and various neurointerventional techniques has changed the outcome of various dreaded situations to a favourable low morbidity and mortality outcome.

Interventional Neurology

Interventional Neurology also known as Neuroendovascular therapy (NET) is a new subspecialty of neurosciences, which deals with vascular lesions of the nervous system in a minimally invasive way. The current applications of Interventional Neurology are in the following diseases:

Disease conditions
Intervention

Acute Ischemic stroke

Intravenous Thrombolysis and

Selective intra-arterial Thrombolytic therapy

Secondary stroke Prevention

Carotid Angioplasty & Stenting (CAS)

Vertebral Agioplasty & Stenting

Intracranial Angioplasty & Stenting

Cerebral AVMs

Intra-arterial Embolization

Spinal AVMs

Intra-arterial Embolization

Cerebral Aneurysm

Aneurysmal Coiling

Parent vessel occlusion with Balloon

Treatment of Complex aneurysms with Flow Reversal Technique

Skull Base Tumors

Pre-operative Embolization to reduce vascularity

Vasospasm in SAH

Selective Spasmolysis (Chemical)

Angioplastgy of Spastic vessel

Dural AVFs

Transvenous/ Transarterial Embolization

Vascular malformations - Head & Neck

Transarterial Embolization

Cerebral venous/Dural sinus thrombosis

Transvenous selective thrombolytic therapy

The approach for these procedures is essentially percutaneous through femoral artery. These procedures are increasingly done in various clinical conditions due to their inherent benefits like:

  • They do not require surgical exposure.
  • They are performed with reduced risk of procedural morbidity and mortality.
  • They can be done even in poor clinical grades.
  • In many situations, these procedures are performed under local anesthesia, 
  • short hospital stay and early mobilization of patient.

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