Basic Neuro-Interventional Therapeutic Approaches

Abstract

The minimally invasive procedures used by interventional neuroradiologists accomplish a wide variety of treatments designed to provide correct life-threatening conditions, such as haemorrhagic or ischemic stroke. Endovascular treatment strategies of haemorrhagic intracranial aneurysms include coiling, balloon-assisted coiling, intrasaccular flow-disruptors, stent-assisted coiling, and flow-diverter devices. Interventional neuroradiology allows also minimally invasive treatments of haemorrhagic stroke, which are due to an underlying vascular lesion such as arteriovenous malformations or dural arterio-venous fistulas. Embolization with acrylic glues or with non-adhesive embolic materials may be used for “target” embolization in the setting of intracerebral haemorrhage. Finally, endovascular treatment of acute ischemic stroke is now the younger field of interventional neuroradiology. It is important to recognize that modern endovascular stroke therapy focuses on direct clot removal with mechanical devices and it represents the standard of care in cases of proximal large vessel occlusion of the anterior circulation. In this chapter, we review the current practice on neuroendovascular therapy in acute phase and we discuss the main techniques used by interventional neuroradiologists.