ENDOVASCULAR SURGICAL APPROACH TO INTRACRANIAL VASCULAR DISEASES

Purpose: The endovascular surgical approach to complex disorders of th e central nervous system has made rapid and significant advancements o ver the past decade. Patients with intracranial arterial aneurysms, tr aumatic carotid and vertebral artery lesions, including fistulas and p seudoaneurysms, hemodynamically significant atherosclerotic lesions, v asospasm, and acute stroke are now being approached and treated by new er and less invasive techniques, including cerebral angioplasty and th rombolytic therapy. Methods: All procedures are usually performed from a transfemoral approach utilizing a variety of occlusion devices, inc luding detachable silicone balloons, microcoils, electrolytic detachab le coils, liquid tissue adhesives, and particulate emboli for vessel o cclusion. For dilatation and reperfusion of vessels, balloon angioplas ty catheters, stents, and thrombolytic drugs are being used.Results: F or the treatment of traumatic vascular injuries, such as carotid caver nous sinus fistulas and vertebral arteriovenous fistulas and pseudoane urysms, endovascular therapy has become the treatment of choice. The e ndovascular approach for intracranial aneurysms is emerging as a thera peutic option in selected cases. For occlusive disorders in patients p resenting with acute cerebral ischemia, extracranial angioplasty and c erebral thrombolysis techniques are currently under investigation. Con clusions: As these techniques continue to evolve, the field of interve ntional neuroradiology will expand the therapeutic options for managin g complex cerebrovascular disorders and improve patient outcome in acu te stroke therapy.