PART I FUNDAMENTALS CHAPTER 1 Tools of the Trade 1 J.J. Connors III, J.C. Wojak, and Z. Qian Routine Supplies for Interventional Neuroradiology Cases Puncture Systems Hemostatic Devices Guidewires * Neuro-Sheaths Guide Catheters * Flow Control Catheters Temporary Test Occlusion Balloon Catheters Angioplasty Balloon Catheters Microcatheters * Atherosclerotic Microangioplasty Catheters Vasospasm Microangioplasty Cathe- ters * Venting Catheters Temporary Stenting Catheters Snares Embolectomy Devices Commercial and Investiga- tive Metallic Stents Particulate Embolic Agents Mechanical Embolic Agents Liquid Embolic Agents Air Filters Microtubing Large-Bore Y Connectors Steamers * Isotonic Iso-Osmolar Nonionic Contrast Temporary Pacemakers Vertebral Body Biopsy Needles CHAPTER 2 Future Devices and Procedures 38 J.J. Connors ill and J.C. Wojak Paving Stents Spherical Coils and Three-Dimensional Coils Advanced Embolic Agents Monitoring Guidewires Microminiaturized Tools Percutaneous Dilation ofAqueductal Stenosis Alternative Inflation Methods for Angioplasty Balloons Beta Radiation Delivery Catheter System Radioactive Stents Cutting Balloons Infiltrating Angioplasty Balloons Multiballoon Angioplasty Systems Excimer Laser Ablation Vascular Recanalization CHAPTER 3 Tricks of the Trade 41 J.J. Connors III and J.C. Wojak Diamox Challenge Test How to Test a Vessel Before Embolization (Provocative Testing) How to Mix Particles How to Mix and Use Avitene How to Load Silk for Embolization How to Use Alcohol Embolizing With Coils How to Mount a Detachable Balloon Propping a Balloon Steering a Detachable Balloon How to Use a Snare * Preparing a Large-Lumen Intravascular Withdrawal System for a Foreign Body How to Steam a Catheter How to Use the Intime Catheter Steering a Flow-Directed Catheter into the Anterior Rather Than the Middle Cerebral Artery How to Introduce a Guide Catheter Directly Through the Skin Dealing With Unwanted Hydrophilic Coating Accurate Mea- surement of a Vessel, Stenosis, Aneurysm, or Other Structure Puncture Through a Graft Safe Catheterization of Difficult and/or Tortuous Vessels Protective Embolization of Vital Vessels Prevention of Catheter-Induced Spasm Spinal Angiography Carotid Compression Procedure for Carotid-Cavernous Fistulae Direct Puncture of the Carotid Artery Useful Measurements and Conversions CHAPTER 4 Pharmacology in Interventional Neuroradiology 59 J.C. Wojak Embolic Agents Local Anesthetics Sedation Analgesia Anticonvulsants Antiemetics Antibiotics * Antihyper- tensives Antiulcer Agents * Neuroprotectants Cardiovascular Agents Drugs for Functional Neurologic Testing An- ticoagulants and Antiplatelet Drugs Vasodilators Thrombolytic Agents Miscellaneous Pharmaceuticals CHAPTER 5 Fundamental Neurovascular Anatomy 77 J.C. Wojak Dangerous Extracranial-Intracranial Anastomoses Persistent Primitive Anastomoses from the Anterior Circulation to the Posterior Circulation Intrinsically Dangerous Vessels Vascular Supply to the Spinal Cord Intracranial Vascular Territories xviii Contents CHAPTER 6 Neurologic Correlates of Cerebrovascular Occlusions 84 D.v. Rodriguez Specific Vessels and Associated Findings CHAPTER 7 General Preprocedure and Postprocedure Orders 89 J.C. Wojak Preprocedure Orders Postprocedure Orders Additional Medications (As Needed for Specific Cases) PART II EMBOLIZATION CHAPTER 8 General Principles of Embolization 93 J.J. Connors ill and J.C. Wojak Pathologies Amenable to Embolotherapy General Technique of Embolization * Extra-Axial Tumors * CHAPTER 9 Meningiomas 100 J.J. Connors III and J.C. Wojak Epidemiology Radiographic Evaluation * Preoperative Embolization Inoperable Tumors CHAPTER 10 Juvenile Nasopharyngeal Angiofibromas 121 J.J. Connors ill and J.C. Wojak Epidemiology Clinical Presentation Pathology * Evaluation Endovascular Therapy Recurrence CHAPTER 11 Paragangliomas 130 J.J. Connors ill and J.C. Wojak Tympanic Paragangliomas Jugular Paragangliomas * Carotid Paragangliomas Vagal Paragangliomas Secretory Ac tivity of Paragangliomas/Hypertensive Crisis General Goal of Endovascular Therapy of Paragangliomas Elective Presurgical Internal Carotid Artery Occlusion * CHAPTER 12 Tumors of the Vertebral Bodies and Other Bones 142 J.J. Connors ill and J.C. Wojak Transarterial Vertebral Body Tumor Embolization * Percutaneous Ethanol Ablation of Intraosseous Vertebral Body He- mangiomas Preablation Testing * Percutaneous Vertebroplasty CHAPTER 13 Epistaxis 147 J.J. Connors III and J.C. Wojak Rationale for the Therapeutic Approach to Epistaxis Technique of Therapy for Epistaxis CHAPTER 14 Soft Tissue Tumoral Hemorrhage in the Head and Neck 157 J.J. Connors ill and J.C. Wojak Rationale for Therapy Continued Bleeding from the Tumor Mass Due to Collateral Supply CHAPTER 15 Arteriovenous Fistulae and Traumatic Vascular Lesions 160 J.J. Connors ill and J.C. Wojak General Considerations Traumatic Head and Neck Hemorrhage * Traumatic Arteriovenous Fistulae Pseudoaneu- rysms of Brachiocephalic Vessels Intracranial Pial Arteriovenous Fistulae (Nongalenic) Potential Complications of Therapy of Arteriovenous Fistulae * CHAPTER 16 Endovascular Therapy for Vertebral Artery Arteriovenous Fistulae 180 A. Ayrnard, R. Chapot) E. Houdart, A.E. Casasco, H.S. Jhaveri, D. Reizine, and J.'J. Merland General Considerations Therapeutic Approach Outcome Conclusion CHAPTER 17 Embolization of Spinal Vascular Malformations 186 A.E. Casasco, E. Houdart, H.S. Jhaveri, A. Ayrnard, D. Herbreteau) J.-P. Guichard, D. Reizine) K.L. Mourier, and J.-J. Merland General Concepts Classification General Approach to Treatment Spinal Cord Arteriovenous Malformations Perimedullary Arteriovenous Fistulae Spinal Dural Arteriovenous Fistulae With Perimedullary Venous Drainage Epidural Vascular Malformations Paraspinal Vascular Malformations Cobb's Syndrome * Vertebral Hemangiomas Spinal Cord Tumors * Conclusion CHAPTER 18 Endovascular Therapy and Long-Term Results for Intracranial Dural Arteriovenous Fistulae 198 C. Cognard, E. Houdart, A.E. Casasco, H.S. dhaveri, R. Chapot, and J.'J. Merland Etiology Pathophysiology Classification According to the Type of Venous Drainage and Implications Location Ther- apeutic Approaches Specific Treatment Considerations Relating to Location of the Fistula Spontaneous or Posttreat- ment Modification of Venous Drainage * CHAPTER 19 Treatment of Carotid-Cavernous Sinus Fistulae 215 Donald Larsen, Randall T. Higashida, and J.J. Connors III Etiology Classification Pathophysiology and Clinical Presentation History Radiographic Evaluation Treatment Options Indirect Carotid-Cavernous Fistulae Carotid Compression Maneuver Conclusions * CHAPTER 20 Intracranial Arteriovenous Malformations: General Considerations 227 J.J. Connors ill and J.C. Wojak Spetzier and Martin Grading System General Philosophy of Therapy * Theory of AVM Embolization Techniques of Therapy Materials for Embolization Role of Embolization in Radiosurgery Technical Problems, Complications, and Solutions in AVM Embolization * CHAPTER 21 Intracranial Arteriovenous Malformations: The Approach and Technique of Cyanoacrylate Embolization 240 V.A. Aletich and G.M. Debrun Initial Evaluation Technique Illustrative Cases Risks, Potential Complications, and Solutions * Conclusion CHAPTER 22 Ethanol Endovascular Management of Brain Arteriovenous Malformation: Initial Experience 259 W.F.J. Yokes Rationale for Use Concepts in Patient Management Technical Problems, Complications, and Solutions Discussion CHAPTER 23 The Role of Embolization in Combination with Stereotactic Radiosurgery in the Management of Pial and Dural Arteriovenous Malformations 267 B.E. Pollock, L.D. Lunsford, J.C. Flickinger, and D. Kondziolka Pial Arteriovenous Malformations Dural Arteriovenous Malformations CHAPTER 24 Intracranial Aneurysms: General Considerations 276 J.J. Connors ill and J.C. Wojak Incidence and Natural History Imaging History of Endovascular Therapy Current Endovascular Therapies Management of Therapeutically Challenging Aneurysms Hazards of Aneurysm Embolization Potential Advances in Intracranial Aneurysm Treatment CHAPTER 25 Detachable Coil Embolization of Intracranial Aneurysms 294 M.E. Cronquist and J. Moret Pretherapeutic Evaluation and Indications Limitations in and Contraindications to Endovascular Therapy Technical Devices Procedure Complications and Their Management Interval Angiography and Follow-Up xx Contents PART III MISCELLANEOUS INTERVENTIONAL NEURORADIOLOGIC PROCEDURES CHAPTER 26 Current Management of Cervicofacial Superficial Vascular Malformations and Hemangiomas 317 D. Herbreteau, A. Ayrnard, H.S. Jhaveri, R. Chapot, A.E. Casasco, S. Slaba, E. Houdart, and J.'J. Merland Hemangiomas Vascular Malformations CHAPTER 27 Management of Extracranial Head and Neck and Paraspinal Vascular Malformations 327 W.F.J. Yakes General Concepts of Therapy Classification of Hemangiomas and Vascular Malformations * Rationale for Therapy Em- bolic Agents Initial Evaluation Concepts in Patient Management Complications * CHAPTER 28 Percutaneous Direct Embolization of Head and Neck Vascular Tumors 338 A.E. Casasco, E. Houdart, H.S. Jhaveri, D. Herbreteau, A. Ayrnard, B. George, M. Wassef, P.T. Ba Huy, and J.-J. Merland General Technique Strategy- of Treatment of Specific Tumors Pre-Embolization Patient Preparation and Percutaneous Puncture Techniques Postembolization Care and Follow-Up Results Technical Problems, Complications, and Solu- tions Conclusion CHAPTER 29 Percutaneous Vertebroplasty: Indications, Technique, and Complications 346 c. Depriester, H. Deramond, P. Toussaint, H.S. Jhaueri, and P. Galibert Pathologies Amenable to Treatment Materials and Devices Preprocedure Orders * Description of Procedure * Post- procedure Orders Technical Incidents and Complications CHAPTER 30 A Treatment for Head and Neck Cancer by Direct Arterial Infusion 358 C.w. Kerber, W.H.M. Wong, and K.T. Robbins Background and History Theory General Approach to Evaluation and Treatment * Technique Results Technical Pitfalls, Complications, and Solutions Summary CHAPTER 31 Intra-Arterial Chemotherapy for Central Nervous System Tumors 368 Jacques Chiras Background Pharmacologic and Experimental Data Techniques of Infusion Conclusion CHAPTER 32 Interventional Neuroradiologic Procedure for Wada Testing 372 J.J. Connors ill and J.C. Wojak Applications Procedure False-Positive Wada Test CHAPTER 33 Intracarotid Amobarbital (Wada) Test: Neurology Perspective 374 Piotr Olejniczak and Bruce Fisch Procedure Applications CHAPTER 34 Temporary Test Occlusion of the Internal Carotid Artery 377 J.J. Connors ill Indications Tools Technique Variations What Is a Temporary Test Occlusion Failure? Technical Problems, Com- plications, and Solutions False-Negative and False-Positive Test Results CHAPTER 35 Permanent Occlusion of the Internal Carotid Artery 390 J.J. Connors ill Rationale for Procedure Technical Theory Specific Technique Single-Photon Emission Computed Tomography Follow- ing Balloon Occlusion Alternative TechniqueFibered Coils Technical Problems, Complications, and Solutions CHAPTER 36 Endovascular Test and Permanent Occlusion of Extracranial and Intracranial Cerebral Vessels: Indications, Techniques, and Management 394 J.N. Vallee, A. Ayrnard, A.E. Casasco, H.S. Jhaveri) E. Houdart, and J.'J. Merland General Considerations Internal Carotid Artery Common Carotid Artery Vertebral Artery Intradural Vessels Complications Follow-Up * Conclusion CHAPTER 37 Endovascular Treatment of Traumatic Lesions in Supra-Aortic Vessels With Stent-GraftS 408 J.C. Parodi and C.J. Schonholz History * General Approach Results Complications Follow-Up Conclusions CHAPTER 38 Inferior Petrosal Sinus Sampling 411 J.J. Connors ill and J.C. WoJak Rationale for Procedure Technique of Sampling Technical Problems, Complications, and Solutions CHAPTER 39 Nerve Blocks and Discectomy 421 J.C. Wojak and J.J. Connors ill Nerve Blocks Discectomy CHAPTER 40 Percutaneous Treatment of Cervical and Lumbar Disc Herniations 424 J.G. Theron Treatment Options Indications Choice of Procedure Pretherapeutic Consultation Technique Technical Problems, Complications, and Solutions Conclusion PART IV BRACHIOCEPHAUC ANGIOPLASTY AND STENTING CHAPTER 41 General Concepts of Brachiocephalic Angioplasty for Atherosclerosis 431 J.J. Connors ill Importance and Implications of Degree of Stenosis Ongoing Clinical Trials Locations of Atherosclerotic Brachiocephalic Disease General Theory of Angioplasty and Pathophysiologic Response Angioplasty and Fibrinolysis Restenosis CHAPTER 42 General Technique of Extracranial Angioplasty and Stenting 438 J.J. Connors ill Tools for Extracranial Angioplasty and Stenting Preliminary Evaluation Indications Contraindications Preproce- dure Preparation Procedural Technique for Extracranial Angioplasty Postprocedure Care Probucol Follow-up CHAPTER 43 General Considerations for Endovascular Therapy of the Extracranial Internal Carotid Artery at the Bifurcation 442 J.J. Connors ill Natural History of the Disease Carotid Endarterectomy Advantages of Carotid Angioplasty * Disadvantages and Risks of Carotid Angioplasty Rationale for Stent Use Cerebral Protection During Internal Carotid Angioplasty Distal Perfusion During Angioplasty Asystole After Carotid Stenting The Future of Endovascular Carotid Artery Therapy CHAPTER 44 Cervical Carotid Angioplasty and Stent Placement for Atherosclerosis 456 V. Wadlington, J. Yadau, J. Vitek, M. Parks) S. lyer) and G. Roubin Patient Selection Angioplasty Risks Surgical Risks * Preparation * Angioplasty and Stent Procedure Postangi- opIasty/Stenting Results Postangioplasty Management Follow-Up Conclusions CHAPTER 45 Protected Angioplasty and Stenting of Atheroscierotic Stenosis at the Carotid Artery Bifurcation 466 J.G. Theron Evolution of the Techniques of Protected Angioplasty and Protected Stenting Role of Digitized Parenchymography in Patient Evaluation Current Periprocedural Medication Protocol Complications and Solutions CHAPTER 46 Current Status and Future Possibilities of Balloon Angioplasty in the Carotid Artery 473 R. Rachel Balloon Angioplasty as a Controlled Injury * Indications for Carotid Angioplasty Without Stenting (Conventional) Pre- therapeutic Diagnostic Methods Patient Preparation Materials Method Postprocedure Management Results Cerebral Protection * To Stent or Not to Stent CHAPTER 47 Other Extracranial Locations Amenable to Angioplasty and Stenting 484 J.J. Connors ill Origin of the Left Common Carotid Artery from the Aorta Innominate Artery Subclavian Artery Cervical Carotid Artery Other Than at the Bifurcation Vertebral Artery Origin CHAPTER 48 Intracranial Angioplasty 500 J.J. Connors ill General Considerations Location of Intracranial Atherosclerotic Disease Rationale for Treatment of Intracranial Steno- ses Technique of Elective Intracranial Angioplasty Strategy and Technique of Penetrating a Total Intracranial Vascular Occlusion With Downstream Ischemia Complications of Intracranial Angioplasty and How to Avoid Them CHAPTER 49 Surgical Alternatives to Interventional Neuroradiology 555 J.R. Tompkins and R Culicchia History Indications for Cerebral Revascularization Extracramal-intracranial Surgical Revascularization Operative Procedures * Results Postoperative Care Conclusions CHAPTER 50 Clinical Applications of Intravascular Ultrasound 561 S.P. Jain and S.R. Ramee Currently Available Devices * New Devices Ultrasound Image Interpretation Reproducibility Safety Issues Limi- tations Clinical Utility of Intravascular Ultrasound Conclusions PARTY POSTSUBARACHNOID HEMORRHAGE VASOSPASM CHAPTER 51 Endovascular Therapy of Postsubarachnoid Hemorrhage Vasospasm 581 J.J. Connors ill and J.C. Wojak Evaluation of Intracranial Vasospasm Radiographic Manifestations Therapeutic Options CHAPTER 52 Medical Management of Vasospasm and Hemodynamic Alterations in the Neurosurgical ICU 602 C. Paoletti, C. Dematons, C. Bellec, J.L. Raggueneau, D. Payen de la Garanderie, L. Do, G. Lot, B. George, J. Cophignon, and J.-J. Merland Postembolization Care After Aneurysmal Subarachnoid Hemorrhage Monitoring and Care After Balloon Occlusion of the Internal Carotid Artery PART VI EMERGENCY TREATMENT OF ACUTE ISCHEMIC STROKE CHAPTER 53 General Considerations in Emergency Stroke Therapy 613 J.J. Connors ill and J.C. Wojak History * Rationale for Emergency Cerebral Revascularization CHAPTER 54 Medical Aspects of Cerebral Ischemia 616 L.A. Weisberg Risk Factors for Ischemic Stroke Neuroloc Risk Factors for Stroke Diagnostic and Treatment Strategies Manage- ment of the Patient With Transient Ischemic Attacks Cerebral Blood Flow and Metabolism Management of Acute Cerebral IschemiCHAPTER 55 Cerebral Protection 626 J.C. Wojak Barbiturate Therapy for Pre-Emptive Cerebral Protection Hypothermia CHAPTER 56 Current Directions in Emergency Stroke Therapy 629 J.J. Connors ill and J.C. Wojak Early Results of Neuroprotectant Agent Trials Fibrinolytic Agents Results of Early Intravenous Fibrinolytic Thera- pies National Institute of Neurological Disorders and Stroke Tissue Plasminogen Activator Stroke Trial Results of Early Intracranial Local Intra-arterial Fibrinolysis Ongoing Local Intra-arterial Fibrinolysis Trials Retrograde Venous Neuroperfusion Hyperbaric Oxygen Hypothermia CHAPTER 57 Radiology of Emergency Stroke Therapy 644 P. Mohanakrishnan, J.J. Connors ill, and J.C. Wojak Initial Computed Tomography Scan Follow-Up Computed Tomography Scan Magnetic Resonance Imaging Angiogra- phy CHAPTER 58 Strategic Considerations Concerning Emergency Stroke Treatment 650 J.J. Connors ill and J.C. Wojak General Considerations Regarding Fibrinolysis Rationale for Intravenous Versus Intra-Arterial Fibrinolytic Therapy Timing of Therapy Time Versus Diagnostic Information Heart Versus Brain (Rationale for Different Therapies for Coronary and Cerebral Vascular Occlusions) The Need to Reestablish Flow: Mechanical Versus Fibrinolytic Means Factors Affecting Success of Fibrinolytic Therapy for Acute Stroke Factors Associated With Intraparenchymal Hema- toma and Poor Outcome Other Predictors of Poor Outcome Optimal Emergency Stroke Therapy CHAPTER 59 Specific Stroke Situations, Territories, and Guidelines for Therapy 2 J.J. Connors ill and J.C. Wojak Vertebrobasilar Stroke Anterior Circulation Stroke Dural Sinus Thrombosis Treatment of a Stroke During or Subse- quent to an Angiographic Procedure CHAPTER 60 Specific Technical Procedure of Emergency Intracranial Fibrinolysis 751 J.J. Connors ill and J.C. Wojak Getting Started Dose of Heparin Choice of Microcatheter Microcatheter Tip and Guide Catheter Localization Es- tablishing Antegrade Flow Dose of Fibrinolytic Agent Choice of Contrast Material Dealing With Resistant Throm- bus Chasing the Clot When to Stop Postprocedure Management Aspirin and Acute Stroke Therapy ReoPro (abciximab) and Acute Stroke Therapy CHAPTER 61 Technique of Superselective Intraophthalmic Artery Fibrinolytic Therapy Using Urokinase for Central Retinal Vein Occlusion 756 J.N. Vallee, H.S. Jhaueri, M. Tovi, P.Y. Santiago, P. Paques, A. Gaudric, and J.-J. Merland Inclusion Criteria Exclusion Criteria Technique Results * Conclusion CHAPTER 62 Management of Intracranial Hemorrhage During Thrombolysis 759 J.C. Wojak CHAPTER 63 Treatment and Prevention of Acute Ischemic Stroke by Endovascular Techniques: A Network-Based Community Model 760 B.L. Berger and A.S. Callahan ill Background Screening Acute Treatment Results Aftercare Technical Problems, Complications, and Solu- tions Benefits of a Dedicated Endovascular Service Referrals Future Trends PART VII COMPLICATIONS OF INTERVENTIONAL NEURORADIOLOGIC PROCEDURES AND THEIR TREATMENT CHAPTER 64 Problems, Complications, and Solutions in Embolization 768 J.J. Connors ill and J.C. Wojak Microparticulate Pulmonary Embolism Cranial Nerve Damage Cardiopulmonary Collapse After Ethanol Emboliza- tion Tissue Necrosis Coil Malposition Balloons Postembolic Syndrome Hypertensive Crisis Normal Perfusion Pressure Breakthrough Failure of Residual Trunk Patency: Retrograde Thrombosis Catheter Occlusion Problems Associated With Flow-Directed Catheters CHAPTER 65 Rupture of a Vessel, Aneurysm, or Arteriovenous Malformation 775 J.J. Connors ill and J.C. Wojak Intracranial Vascular Perforation Ruptured Arteriovenous Malformation Aneurysm Rupture CHAPTER 66 Other Problems, Complications, and Solutions 777 J.J. Connors ill and J.C. Wojak Urokinase Chills Broken Catheter Intraprocedural Vasospasm Dissection Clot Stroke on the Table Cervical Radiculopathy and Peripheral Neuropathy Index 783
京公网安备 11010102004214号