Endovascular treatments

The major disadvantages to endovascular strategies include the complexity of the procedure, the level of required technical expertise, delays in initiating endovascular treatment, and the additional risks and expense of an invasive procedure compared with IV rt-PA. 

The Concentric Retriever (Concentric Medical Inc., Mountain View, CA), a flexible, nitinol wire with helical tapering coil loops (X5 and X6) that is used in conjunction with a balloon guide catheter (8 or 9 French) and a microcatheter, is the only device currently approved by the FDA for the endovascular treatment of stroke patients (Fig. 4.3). The second-generation devices (L5 and L6) differ from the X devices by the inclusion of a system of arcading filaments attached to a nontapering... 

Ueda T, Hatakeyama T, Kohno K, Kumon Y, Sakaki S. Endovascular treatment for acute thrombotic occlusion of the middle cerebral artery local intra-arterial thrombolysis combined with percutaneous transluminal angioplasty. Neuroradiology 1997 39 99-104. 

Nesbit GM, Luh G, Tien R, Barnwell SL. New and future endovascular treatment strategies for acute ischemic stroke. J Vase Interv Radiol 2004 15 S103-S110. 

On the other hand, low intensive laser irradiation (LILI) was used for endovascular treatment of blood for different pathological conditions including myasthenia [4]. However the influence of the LILI on blood cells and particularly on erythrocytes has not been investigated. 

Dorffler-Melly J, Koopman MM, Prins MH, Buller HR. Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment. Cochrane Database Syst Rev. 2005 CD002071. 

Dorffler-Melly J, Mahler F Do DD, Triller J, Baumgartner I. Adjunctive abeiximab improves patency and functional outcome in endovascular treatment of femoropopliteal occlusions initial experience. Radiology 2005 237(3) I 103-1 I 19. 

Song JK, Vinuela F, Gobin YP, Duckwiler GR, Murayama Y, Kureshi I, Frazee JG, Martin NA (2001) Surgical and endovascular treatment of spinal dural arteriovenous fistulas long-term disability assessment and prognostic factors. J Neurosurg 94 199-204... 

CT venography of cerebral veins is a very reliable technique for the demonstration of intraluminal abnormalities of dural sinuses (Figs. 18.10a, 18.12a Ozsvath et al. 1997). In particular, multisection CT venography with subtraction of bone is a promising and competitive technique for the evaluation of veno-occlusive disorders of the cerebral veins and sinuses (Majoie et al. 2004). One disadvantage, however, is the radiation exposure. Conventional DSA is typically not needed unless endovascular treatment is necessary, since MRI, MRA and CT are usually sufficient to make a correct diagnosis. 

Cronqvist M, Pierot L, Boulin A, Cognard C, Castaings L, Moret J. Local intraarterial fibrinolysis of thromboemboli occurring during endovascular treatment of intracerebral aneurysm a comparison of anatomic results and clinical outcome. AJNR Am J Neuroradiol 1998 19(l) 157-65. 

Endovascular treatment was first used in the Umbs in the 1960s and subsequently in the renal and coronary arteries (Dotter et al. 1967), but it was introduced more cautiously for treatment of stenosis of the cerebral, carotid and vertebral arteries because of the perception of a likely high procedural risk of stroke. 

Wiebers DO, Whisnant JP, Huston J III et al. (2003). Unruptured intracranial aneurysms natural history, clinical outcome and risks of surgical and endovascular treatment. Lancet 362 103-110... 

Lubicz B, Leclerc X, Levivier M et al. Retractable self-expandable stent for endovascular treatment of widenecked intracranial aneurysms prehminary experience. Neurosurgery. 2006 58 451-457 discussion 451-457... 

S.K. Kakkos, R. Haddad, G.K. Haddad, D.J. Reddy, T.J. Nypaver, J.C. Lin, A.D. Shepard, Results of aggressive graft surveillance and endovascular treatment on secondary patency rates of Vectra Vascular Access Grafts, J. Vase. Surg. 45 (2007) 974-980. 

Qureshi, A.I. (2004) Endovascular treatment of cerebrovascular diseases and intracranial neoplasms. Lancet, 363 804-813. 

Taschner, C. A., Leclerc, X., Rachdi, H., Barros, A. M. Pruvo, J.-P. (2005) Matrix detachable coils for the endovascular treatment of intracranial aneurysms analysis of early angiographic and clinical outcomes. Stroke, 36, 2176-2180. 

Valavanis, A., Pangalu, A. Tanaka, M. (2004) Endovascular treatment of cerebral arteriovenous matformations with emphasis on the curative role of embolisation. Swiss Archives of Neurology and Psychiatry, 155, 341—347. 

Lot G, Houdart E, Cophignon J, Casasco A and George B (1999), Combined management of intracranial aneurysms by surgical endovascular treatment. Modalities and results from a series of 395 cases , Acta Neurochir (Wien), 141, 557-562. 

Park H, Horowitz M, Jungreis C, Kassam A, Koebbe C, Genevro J, Dutton K and Purdy P (2003), Endovascular treatment of paracbnoid aneurysms experience with 73 patients . Neurosurgery, 18, 43 14. 

The advance of endovascular therapy for aorto-iliac aneurysmal disease has also brought about yet another flourishing application of embolotherapy. Embolization of the internal iliac artery plays an important adjunct initial modality to allow endovascular treatment of aortic aneurysms with extension into the common iliac arteries [78-80], It also plays an crucial role in the secondary management of complications related to endoleaks [81-84],... 

Raymond J, Roy D, Leblanc P, et al. (2003) Endovascular treatment of intracranial aneurysms with radioactive coils initial clinical experience. Stroke 34 2801-2806... 

Ultrasound is useful for many aspects of pancreatitis but has a sensitivity of less than 73% for visceral pseudoaneurysm in the condition, vdiereas contrast enhanced computer tomography (CECT) has a sensitivity of almost 100% [22]. CECT is also very useful in terms of endovascular treatment as it can indicate what type of aneurysm has formed, which artery it has formed from and whether there is more than one. 

Digital subtraction angiography (DSA) remains the gold standard for characterization of the endoleaks and their endovascular treatment. 

Haulon S, Lions C, McFadden EP, Koussa M, et al (1998) Prospective evaluation of magnetic resonance imaging after endovascular treatment of infrarenal aortic aneurysms. Eur J Endovasc Surg 22 62-69... 

Table 15.1. Summary of studies reporting embolization of internal iliac arteries in association with endovascular treatment of aortoiliac aneurysms...

Tefera G, turnipseed WD, Carr SC et al. (2004) Is coil embolization of hypogastric artery necessary during endovascular treatment of aortoiliac aneurysms Ann Vase Surg 18 143-146... 

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