Endovascular approach

Guluma KZ, Hemmen TM, Olsen SE, Rapp KS, Lyden PD. A trial of therapeutic hypothermia via endovascular approach in awake patients with acute ischemic stroke methodology. Acad Emerg Med 2006 13(8) 820-827. 

Fifteen years ago, the only option for patients with large abdominal aortic aneurysms (AAA) that required either elective or emergent repair was an open surgical approach using a transperitoneal or retroperitoneal incision. Now with the advent of endovascular approaches to aortic diseases, many patients, especially those in the high-risk groups, have a minimally invasive option to permit repair of aortic aneurysms, dissections, pseudoaneurysms, and ruptures. 

Strong evidence supports the natural idea that recanalization of the occlusion and resulting tissue reperfusion translate into improved clinical outcomes (Fig. 12.4) [6, 9, 10]. While there is no randomized controlled trial data comparing lAT and intravenous therapy for PAO, multiple studies demonstrate improved rates of revascularization with lAT [6,11-13]. The promise of endovascular stroke therapy has led to the recent emergence of multiple stroke devices. Prospective, industry-sponsored trials of these devices have utilized reperfusion as their primary endpoint [6, 14, 15]. However, there is growing criticism of this emphasis on revascularization in lieu of clinical outcome [16,17]. Indeed, the clinical success of the endovascular approach is highly variable for incompletely understood reasons. 

Nogueira RG, Yoo AJ, Buonanno FS, Hirsch JA. Endovascular approaches to acute stroke, part 2 a comprehensive review of studies and trials. AJNR Am J Neuroradiol. 2009 30 859-875... 

Guglielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2 Preliminary clinical experience [see comment], J Neurosurg 75 8-14... 

The endovascular approach sometimes fails and a complex neurosurgical approach becomes necessary. 

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