Non-traumatic neurological emergencies: emergency neuroradiological interventions

Abstract

This article summarizes recent developments in the growing field of interventional neuroradiology for the treatment of acute cerebrovascular disease. We describe the possibilities in endovascular therapy of acute cerebral aneurysms using electrolytically detachable coils combined with trispan neck bridging devices and stent implantation to occlude acute wide neck aneurysms. Techniques and results of local intra-arterial thrombolytic therapy in acute stroke and central retinal artery occlusion are described and we discuss the potential for rapid, large-burden thrombus removal in cases of internal carotid artery thrombosis by rheolytic thrombectomy, percutaneous transluminal angioplasty and stent implantation. Emergency endovascular therapy using the transvenous approach to treat severe intracranial or intraocular hypertension and multifocal haemorrhagic venous infarction due to cerebral sinus thrombosis or dural fistulas is also described. In cases of acute bleeding of head and neck lesions following trauma, tumours after radiotherapy, arteriovenous malformations, epistaxis or from iatrogenic origin, angiography plays a major role in localizing the source of bleeding and occluding the damaged vessel during the same session using the same endovascular approach.

Internal Carotid Artery Aneurysm With Life-Threatening Hemorrhages in a Pediatric Patient:Endovascular Treatment Options

“…Another possible treatment that would preserve the carotid artery lumen is stent implantation over the neck of the aneurysm. 9,11,14 Our selection of an endovascular treatment was mainly influenced by the position of the aneurysm near the skull base and the high risk of conventional surgery. Moreover, the absence of an acute hemorrhage during diagnostic DSA allowed staged treatment in our patient.…”

“…In the scenario of disease progression, placement of coils through the mesh of the stent can be effective, 15 as is coaxial placement of a second Wallstent. 14 However, this would have precluded further endovascular intervention if the doubled stent mesh could not inhibit blood flow into the aneurysm. Therefore, we opted to definitively exclude the aneurysm with a covered stent placed inside the bare stent.…”