INTERVENTIONAL NEUROVASCULAR TECHNIQUES IN THE TREATMENT OF STROKE - STATE-OF-THE-ART THERAPY

Interventional neurovascular techniques for the treatment of patients presenting with symptoms of acute or impending stroke, are now being u tilized with increasing frequency in three major areas. (i) For patien ts presenting with cerebrovascular ischaemic symptoms due to haemodyna mically significant stenosis from atherosclerosis, vasculitis, intimal hyperplasia, and dissection, cerebral percutaneous transluminal angio plasty has been shown to be beneficial for both extracranial and intra cranial disease. (ii) Patients with acute, embolic occlusion of the in ternal carotid, middle cerebral, distal vertebral, and basilar arterie s have been successfully treated by placement of microcatheters direct ly into the thrombus with successful thrombolysis, recanalization, and reperfusion to the distal ischemic brain. (iii) Acute arterial vasosp asm secondary to subarachnoid haemorrhage is now being managed by ball oon angioplasty in those instances where conventional medical therapy has failed. These techniques are altering our current management and b roadening the therapeutic alternatives for patients who present with a cute cerebrovascular insufficiency and stroke in evolution. As wider e xperience is gained in these techniques, the clinical indications for their use will also broaden.