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An Overview of the Endovascular Treatment of Intracranial Aneurysms

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Textbook of Catheter-Based Cardiovascular Interventions

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Abstract

Endovascular treatment has become the mainstay of treatment for most ruptured and many unruptured cerebral aneurysms. This chapter first discusses key evidence for this development and presents the equipment and procedures for standard unassisted coiling of cerebral aneurysms. Major complications and management/preventive measures are reviewed together with adjunctive issues such as anaesthesia, anticoagulation and post-procedural care. Then, simpler assist techniques for aneurysm coiling (balloon remodelling and the double microcatheter approach) are described. The second section of the chapter covers reconstructive approaches to the treatment of complex aneurysms. Indications for the use of devices such as stents, flow diverters, other neck bridge devices and intrasaccular flow disruption devices are discussed, and an overview of the evidence for their use provided. Practical technical considerations specific to the use of these devices are presented and complications discussed for each class of device. The final section of the chapter discusses deconstructive and combined endovascular therapy options, along with necessary occlusion testing. The procedural and technical aspects of parent vessel occlusion are presented along with key management tips. A brief overview of combined approaches is given at the end of the chapter. Illustrative figures are provided throughout the text along with key references.

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Notes

  1. 1.

    Roadmaps (trace subtract fluoroscopy) are produced when a peak bolus is automatically traced over the area in view when contrast is administered under fluoroscopy. The resulting image shows a vascular structure as if it were completely filled: the reference image or “roadmap”. Subsequent fluoroscopy shows the progress of the intervention over this reference image. The roadmap image can be faded in/out for enhanced viewing. Run exposure can be performed without losing the roadmap image, saving contrast and X-ray dose. In addition, the subtracted fluoroscopy can be re-masked to compensate for movement.

  2. 2.

    SmartMask™ (or equivalent) simplifies roadmapping procedures by overlaying fluoroscopy with a selected reference digital subtraction angiography image on the live monitor. The reference and fluoroscopy images can be adjusted to preference.

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Authors and Affiliations

  1. Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK

    Phil White

  2. Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    Phil White, Johann du Plessis & Dipayan Mitra

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  1. Middle German Heart Center and Health Care Center Bitterfeld-Wolfen, gGmbH, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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White, P., du Plessis, J., Mitra, D. (2018). An Overview of the Endovascular Treatment of Intracranial Aneurysms. In: Lanzer, P. (eds) Textbook of Catheter-Based Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-55994-0_68

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