NEUROINTERVENTIONAL RADIOLOGY - CURRENT EXPERIENCE AND FUTURE DIRECTIONS
Mark Khangure
Royal Perth Hospital, Perth, WA
Interventional neuroradiology is well established for the treatment of intracranial aneurysms, both acutely ruptured and non-ruptured lesions. The International Subarachnoid Haemorrhage Aneurysm Trial (ISAT), a multicentre study, has demonstrated a significant benefit to patients with acutely ruptured aneurysms who are managed by endovascular means compared with surgical clipping. These aneurysms are treated with platinum coils, but ancillary devices such as micro-balloon catheters, intracranial stents and liquid embolic materials are allowing aneurysms with broad necks to be managed by endovascular means. Bioactive materials, promoting fibroblastic activity and endothelial proliferation, are being incorporated into embolic implantable coils and stents to promote rapid healing. The Interventional Neuroradiology Unit at Royal Perth Hospital is a leader in this field in the Southern Hemisphere, and was the only centre in Australia to be a participant in the ISAT trial.
Stroke prevention and the treatment of acute stroke are rapidly evolving with the utilisation of interventional techniques. Carotid and vertebral artery atherosclerotic stenotic lesions can be elegantly managed by the deployment of stents and acute thrombosis of the vertebrobasilar system and, within a narrow time frame, the anterior circulation can be managed with local intra-arterial thrombolysis.
Carotid artery occlusion tests, pre-operative embolisation of arteriovenous malformations, are integral parts of interventional neuroradiology. Intracranial fistulae and some spinal dural arteriovenous fistulae are primarily managed by endovascular means.
Post-subarachnoid haemorrhage vasospasm, resistant to maximum medical therapy, is managed by intracranial angioplasty, combined with the infusion of intra-arterial vasodilators such as nimodipine, verapamil and occasionally papaverine.
Research and development into the design of self-expanding micro stents, bioactive materials coating the various devices, and further development and refinement of liquid embolic agents will further facilitate the management of stenosed and occluded blood vessels, and the occlusion of abnormal communications with micro-catheters and guidewires steerable to reach distal branches of the intracranial and spinal cord circulation.
Dedicated neuroanaesthesia is an integral part of these procedures which are as demanding as any neurosurgical procedure.
Time of Presentation
Saturday 1 May 2004 - 1030-1200
