Interventional Neuroradiology (Volume 176) (Handbook of Clinical Neurology, Volume 176)

Interventional Neuroradiology, Volume 179, provides a basic outline of the field of interventional neuroradiology that is accessible to fellows, residents, clinicians and researchers in various disciplines, from diagnostic and interventional radiology to vascular neurology, general and vascular neurosurgery, and vascular biology. This volume offers a timely update to experienced clinical practitioners in a logical, easy-to-follow format. Content includes neurovascular anatomy, vascular biology, neurovascular physiology, vascular imaging, as well as sections on the diagnosis and therapeutic treatment of neurovascular disease. Explores the general scope of current clinical interventional neuroradiology, both for endovascular and percutaneous image-guided diagnosis and interventions in a variety of pathologies Defines basic physiological principles (e.g., cerebral perfusion pressure, intracranial pressure, vasospasm, tissue osmolality) with reference to those most essential to the management of neurovascular diseases Discusses pathophysiology and the unique challenges of pediatric cerebrovascular diseases, as well as endovascular and surgical therapies Cover Series Page Series Page Copyright Copyright Handbook of Clinical Neurology 3rd Series Handbook of Clinical Neurology 3rd Series Foreword Foreword Preface Preface Contributors Contributors 1 Neurovascular arterial anatomy: Brain, head, and neck Arch Anatomy Subclavian Artery Common Carotid Artery Internal Carotid Artery Anterior Cerebral Artery Middle Cerebral Artery Vertebral Artery Basilar Artery Posterior Cerebral Artery External Carotid Artery References 2 Neurovascular venous anatomy: Brain, head, and neck Supratentorial Cortical Veins Deep Veins Superficial-to-Deep Anastomoses Posterior Fossa Veins Venous Sinuses Sinuses of the Skull Base Extracranial Veins Veins of the Neck References 3 Neurovascular anatomy: Spine Introduction11Abbreviations used in the chapter are listed at the end of the chapter before References section. Developmental Anatomy The Intersegmental Artery and Its Branches Intersegmental artery origins and trunks Osseous branches Muscular branches The spinal branch of the intersegmental artery Longitudinal arterial chains of the spinal cord Intrinsic arteries of the spinal cord Venous Anatomy of the Spinal Cord Intrinsic venous drainage Extrinsic venous drainage References 4 Brain vascular biology Introduction Brain vascularization under physiologic conditions Formation of initial blood vessels VEGF Wnt G-protein coupled receptor 124 (GPR124) Transforming growth factor β (TGF-β) Maturation of blood vessels Pericytes PDGFB-PDGFR-β TGF-β ECM proteins Pericyte differentiation Astrocytes Wnt Shh SSeCKS Angiotensinogen (AGT) Apolipoprotein E (ApoE) ECM proteins Other factors Brain vascularization under pathological conditions-brain vascular malformation Brain AVMs RAS-MAPK-ERK TGF-β family VEGF PDGFB/PDGFR-β Notch CCMs VEGF Notch Other factors DAVF CM-AVM RASA1 EPHRIN B4 SWS MMD Funding References 5 Neurovascular physiology and neurocritical care Introduction Cerebral Physiology and Intracranial Pressure Cerebral autoregulation Determinants of ICP Measurement of ICP Acute management of elevated ICP Advanced physiologic monitors Cerebral Ischemia Ischemic cascade and the ischemic penumbra BP in acute ischemic stroke Acute BP interventions Postischemic recovery Critical Care of the Perioperative Patient Endovascular stroke therapy Anesthetic considerations Physiologic management during endovascular stroke therapy Subarachnoid hemorrhage Initial physiologic management Vasospasm and delayed cerebral ischemia Revascularization procedures Cerebral hyperperfusion syndrome Conclusion References Further reading 6 Advanced vascular imaging techniques Introduction Noncontrast Magnetic Resonance Angiography Contrast-Enhanced MR Angiography Limitations of TOF MRA and CE-MRA Noninvasive Vessel Wall Magnetic Resonance Imaging Extracranial carotid artery plaque Intracranial atherosclerotic disease Vasculitis Reversible cerebral vasoconstriction syndrome Moya-moya Dissection Cerebral aneurysms Limitations of VWMRI and future application Cerebrovascular Flow Analysis Flow metrics relevant for diagnostics and treatment of cerebrovascular disease Flow measurements with in vivo 4D flow MRI Patient-specific flow models Numerical solution and flow boundary conditions Patient-specific experimental models New DSA Techniques Advantages and limitations of the DSA 3D and 4D DSA Multimodality flow imaging and analysis Conclusion Acknowledgments References 7 Cerebral angiography: Techniques and practice Introduction Preangiography Medications and Allergies Consent Patient examination Laboratory studies Review of previous studies Assessing special needs Documentation of Physical Examination and Consent Patient education Planning the study Team Communication Timeout Monitoring Sedation/Anesthesia Back table organization Radiation and Shielding Patient table Femoral Access Alternative arterial access routes Angiography Catheters Contrast Access closure Management of Complications Postangiography References Further reading 8 Neurovascular disease, diagnosis, and therapy: Brain aneurysms Introduction Epidemiology Pathogenesis Risk of rupture Clinical Symptoms Diagnostics Radiological characteristics of interest for assessment of UIAs Clinical symptoms Risk factors Management Observation vs preventive repair Observation Preventive repair Ongoing Studies and Future Directions Conclusion Disclosure statement Funding References 9 Neurovascular disease, diagnosis, and therapy: Subarachnoid hemorrhage and cerebral vasospasm Epidemiology Natural history of aneurysmal SAH Etiology Subtypes of SAH Nonaneurysmal perimesencephalic SAH Nonaneurysmal, nonperimesencephalic SAH patterns Weather and climate Neuropathology Aneurysm formation and rupture Location, size, and multiplicity Pathology of aneurysm bleeding Pathophysiology of spontaneous SAH Early brain injury Delayed neurologic deterioration and delayed cerebral ischemia Cerebral blood flow and volume changes Clinical Presentation Neurodiagnostics and Imaging Computed tomography Lumbar puncture Magnetic resonance imaging Catheter and CT angiography Hospital Course and Management Initial management and prevention of rebleeding Method of aneurysm repair Delayed cerebral ischemia Diagnosis Prophylaxis and treatment Other neurologic complications Hydrocephalus Seizures Increased intracranial pressure (ICP) Medical complications Prognosis References 10 Brain arteriovenous malformations Introduction Epidemiology Diagnosis Pathophysiology Natural History Grading Management Microsurgical resection Stereotactic radiosurgery Endovascular embolization Conclusions References 11 Cerebral arteriovenous fistulae Dural Arteriovenous Fistulae Transverse sinus dAVF Tentorial dAVF Superior sagittal sinus dAVF Ethmoidal dAVF Marginal sinus dAVF Cavernous Carotid Fistulae Vein of Galen Malformations Pial AVFs References 12 Acute ischemic stroke endovascular therapy Introduction11Abbreviations used in the chapter are listed at the end of the chapter before References section. Importance of Reperfusion The Evolution of LVO Stroke Care Patient Candidacy for Endovascular Therapy Time Clinical severity Age Imaging characteristics Infarct size Advanced imaging Occlusion location Importance of Complete Reperfusion Posterior Circulation Devices and Techniques General Anesthesia vs Conscious Sedation Tandem Lesions Failed Thrombectomy Rescue Permanent Stenting Stroke Systems of Care Conclusion References 13 Hemorrhagic stroke Background Epidemiology Clinical Presentation Causes of ICH Diagnosis Computed tomography MRI/MR venography Digital subtraction angiography Principles of Management Acute blood pressure management Reversal of anticoagulation and platelet dysfunction Management of elevated ICP and edema Management of intraventricular hemorrhage Hemorrhagic cerebral venous thrombosis Surgical management Minimally invasive surgery for ICH Seizure management Control of fever Venous thromboembolism prophylaxis Prognosis in ICH References 14 Neurovascular disease, diagnosis, and therapy: Cervical and intracranial atherosclerosis, vasculitis, and vas ... Cervical Atherosclerosis Introduction: The carotid atherosclerotic plaque Pathogenesis Carotid endarterectomy trials Imaging techniques Catheter angiography Ultrasound MRI CTA Metabolic imaging Treatment Carotid artery stenting Carotid endarterectomy Intracranial Atherosclerosis Introduction Pathophysiology and epidemiology Imaging Digital subtraction angiography Transcranial Doppler ultrasound Magnetic resonance imaging using arterial spin labeling MR angiography Computed tomography angiography (CTA) Acute stroke treatment Vasculitis and Vasculopathy Introduction Large vessel vasculitis Takayasu arteritis Overview Diagnosis Treatment Giant cell arteritis Overview Diagnosis Treatment Medium vessel vasculitis Polyarteritis nodosa Overview Diagnosis and treatment Kawasaki disease Small vessel vasculitis ANCA-Associated Vasculitis Granulomatosis with polyangiitis Overview Diagnosis Eosinophilic granulomatosis with polyangiitis Microscopic polyangiitis Variable vessel vasculitis Behçet's disease Overview Diagnosis and treatment Cogan syndrome Single organ vasculitis (SOV) Primary angiitis of the CNS Overview Diagnosis Treatment Moyamoya disease Vasculitis associated with systemic disease Systemic lupus erythematosus (SLE) Sjogren syndrome Rheumatoid arthritis Vasculitis associated with infection or a specific cause References 15 Spinal vascular malformations: Angiographic evaluation and endovascular management Classification of Spinal Vascular Malformations Spinal arteriovenous malformations Perimedullary arteriovenous fistulas High-flow PmAVFs Low-flow PmAVFs Arteriovenous fistulas at the craniocervical junction Spinal dural arteriovenous fistula Radicular arteriovenous malformations Extradural arteriovenous fistulas High-flow spinal extradural arteriovenous fistulas Low-flow spinal extradural arteriovenous fistulas Clinical Presentation Low-flow spinal vascular malformations High-flow spinal vascular malformations Spinal arteriovenous malformations Perimedullary arteriovenous fistulas High-flow spinal extradural arteriovenous fistulas Noninvasive Imaging Low-flow spinal vascular malformations Conventional MRI Advanced MRI techniques High-flow spinal vascular malformations Conventional MRI Advanced MRI techniques Other imaging techniques CTA CT myelography Conventional contrast-enhanced CT Angiography Patient preparation and pharmacology Level identification Catheterization technique Contrast agent Radiation exposure management Tailored angiography protocols Low-dose protocols Pulsed fluoroscopy Variable frame rates protocols (VFR) High frame rate protocols Collimation Control of geometric factors Gridless spinal angiography Additional factors Three-dimensional angiography techniques Three-dimensional SpDSA (3D-SpDSA) Flat-panel catheter angiotomography (FPCA) Spinal angiography in children Intracanalar and perivertebral arterial networks Multiple radiculomedullary arteries and pseudosteal phenomenon Tortuosity of the anterior spinal artery Evolution of the vertebral blush with age Fast transit times and venous opacification Upper cervical cord blush Angiographic semiology of spinal vascular malformations Spinal arteriovenous malformations Perimedullary arteriovenous fistulas Spinal dural arteriovenous fistulas Radicular arteriovenous malformations Spinal extradural arteriovenous fistulas High-flow venopathy Normal spinal venous phase Treatment Low-flow spinal vascular malformations High-flow spinal vascular malformations Spinal arteriovenous malformations High-flow PmAVFs High-flow spinal epidural arteriovenous fistulas Additional Considerations Multiple spinal vascular malformations Spontaneously resolving spinal vascular malformations Diagnostic errors References 16 Neurovascular disease and syndromes: Diagnosis and therapy in children High-Flow Arteriovenous Shunting Lesions Vein of Galen Malformation Diagnosis and evaluation Treatment Dural Sinus Malformation or Fistula Diagnosis and evaluation Treatment Non-Galenic Arteriovenous Fistula Diagnosis and evaluation Treatment Cerebral Arteriovenous Malformation Diagnosis and evaluation Treatment Associated genetic syndromes Cerebral Aneurysm Diagnosis and evaluation Treatment Associated genetic syndromes Low-Flow Vascular Lesions Associated genetic syndromes Cerebrovascular Occlusive Disease Arterial Ischemic Stroke Diagnosis and evaluation Treatment Associated genetic syndromes Cerebral Venous Sinus Thrombosis Diagnosis and evaluation Treatment Associated genetic syndromes Conclusion References 17 Neurovascular trauma: Diagnosis and therapy Introduction Lesion Types Arterial dissection Arterial pseudoaneurysm Arteriovenous fistula Arterial extravasation Venous lesions Blunt Cerebrovascular Injuries Mechanism Location Classification Diagnosis Indications for evaluation Methods of evaluation Catheter angiography CT angiography MR angiography Management Grade I lesions Grade II lesions Grade III lesions Grade IV lesions Grade V lesions Arteriovenous fistulas Venous lesions Penetrating Cerebrovascular Injuries Mechanism Location Classification Diagnosis Indications for evaluation Methods of evaluation Catheter angiography Doppler ultrasound CT angiography Management Penetrating neck injuries Patients with hard signs of penetrating injury Patients without hard signs of penetrating injury Penetrating head injuries References 18 Vascular anomalies: Classification and management Introduction Vascular Tumors Benign Vascular Tumors Clinical features Morphologic features Management Locally Aggressive Vascular Tumors Malignant Vascular Tumors Vascular Malformations Low-Flow Vascular Malformations Venous malformations Genetics Morphology Treatment Lymphatic malformations Genetics Morphology Treatment Capillary malformations High-Flow Vascular Malformations Genetics Morphology Imaging Treatment Conclusion References 19 Interventional neuro-oncology Introduction Multimodality Imaging and Intervention Suites Enable Advanced Image-Guided Therapy Challenges and Potential Solutions in IAC Pharmacokinetic Advantage of Regionally Targeted IAC Over IV Chemotherapy IAC for Retinoblastoma Blood-Brain Barrier Large Animal Models for IA BBB Manipulation Convection-Enhanced Delivery for Diffuse Intrinsic Pontine Glioma Liposomal Irinotecan CED in Children With DIPG Adult CNS IA Chemotherapy Head and Neck IA Therapy Funding References 20 Vertebral augmentation Introduction Indications for vertebroplasty and kyphoplasty Contraindications Relative contraindications Preprocedural Evaluation History Physical examination Laboratory evaluation Imaging Technique Equipment Sedation Patient positioning Antibiotic prophylaxis and skin preparation Needle placement Vertebroplasty vs kyphoplasty Cement placement Vertebroplasty Kyphoplasty Postprocedure and Follow-Up Care Controversies and Special Topics Bipedicular vs unipedicular approach Volume of cement injection Vertebra plana Fractures with intraosseous vacuum phenomenon (Kummel disease) Malignant fractures with posterior wall osteolysis or epidural tumor extension Safety of multilevel treatment Outcomes Efficacy of vertebral augmentation in providing pain relief and improving quality of life Prospective multicenter randomized sham-controlled studies Prospective multicenter randomized conservative management controlled studies Improved biomechanics after augmentation Complications References 21 ``And do no harm ́ ́: Complications in interventional neuroradiology Overview of Neurointerventional Complications Better Safety Through Knowledge and Planning Communicating and Executing the Plan as a Team Ischemic complications Hemorrhagic complications Practical Considerations for Complication Management Management of ischemic complications Management of intraprocedural hemorrhage Emotional Care After a Complication References 22 Triage and systems of care in stroke Introduction Epidemiology Stroke Systems of Care Triage Prehospital identification Routing of patients Interfacility transport Stroke workflow Conclusion References 23 Emerging stroke systems of care in Germany Standard Workflow Optimization to Reduce Stroke Process Times One-Stop Management Combining Imaging and Treatment in the Angiography Suite Multimodal Stroke Imaging: Which Scans Are Needed and How Many of Them? References Index Index