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Endovascular Treatment of Intracranial Stenosis and Vasospasm

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Handbook of Cerebrovascular Disease and Neurointerventional Technique

Part of the book series: Contemporary Medical Imaging ((CMI,volume 1))

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Abstract

This chapter discusses techniques for intracranial angioplasty and stenting for atherosclerotic arterial stenosis, and angioplasty and intra-arterial drug infusion for cerebral vasospasm after aneurysmal SAH. Position Statement on Intracranial Angioplasty and Stenting for Cerebral Atherosclerosis by the ASITN, SIR, and ASNR: (1) For symptomatic patients with >50% intracranial stenosis who have failed medical therapy, balloon angioplasty with or without stenting should be considered; (2) Patients who have an asymptomatic intracranial arterial stenosis should first be counseled regarding optimizing medical therapy. There is insufficient evidence to make definite recommendations regarding endovascular therapy in asymptomatic patients with severe intracranial atherosclerosis. They should be counseled regarding the nature and extent of their disease, monitored for new neurological symptoms, and have periodic noninvasive imaging at regular intervals of 6–12 months (MRA or CTA) initially, and later with cerebral angiography if warranted. Optimal prophylactic medical therapy should be instituted, which might include antiplatelet and/or statin therapy; and (3) Continued evaluation and improvements in both pharmacological and catheter-based therapies are needed to reduce the possibility of stroke from intracranial atherosclerosis.

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Notes

  1. 1.

    ASITN, American Society of Interventional and Therapeutic Neuroradiology; SIR, Society of Interventional Radiology; and ASNR, American Society of Neuroradiology.

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Authors and Affiliations

  1. Department of Surgery, Division of Neurosurgery, and Departments of Radiology and Neurology, University of Alabama, Birmingham, AL, USA

    Mark R. Harrigan M.D.

  2. Bayfront Medical Center, St. Petersburg, FL, USA

    John P. Deveikis M.D.

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  1. Mark R. Harrigan M.D.
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  2. John P. Deveikis M.D.
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Harrigan, M.R., Deveikis, J.P. (2013). Endovascular Treatment of Intracranial Stenosis and Vasospasm. In: Handbook of Cerebrovascular Disease and Neurointerventional Technique. Contemporary Medical Imaging, vol 1. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-946-4_11

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  • DOI: https://doi.org/10.1007/978-1-61779-946-4_11

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61779-945-7

  • Online ISBN: 978-1-61779-946-4

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