Indications and Recommendations for Intracranial Endovascular Neurointerventional Procedures

Intracranial endovascular cerebrovascular interventions treat cerebrovascular diseases by use of minimally invasive intravascular techniques.

Indications and Recommendations for Endovascular Procedures

Indications Recommendations
Cerebral aneurysm
Ruptured with SAH If amenable to endovascular treatment according
to endovascular specialist
Should be considered for endovascular
occlusion
Unruptured If amenable to endovascular treatment according
to endovascular specialist
Reasonable to consider endovascular
occlusion
Intracranial atherosclerosis
Symptomatic stenosis For symptomatic atherosclerotic stenosis >70%
failing medical therapy
May be reasonable to consider endovascular
revascularization with angioplasty or stenting
Acute ischemic stroke
Intra-arterial
thrombolysis
For patients with major stroke syndrome of <6
hours’ duration and ineligible for intravenous
thrombolysis
Reasonable to consider intra-arterial
thrombolysis in selected patients
Mechanical disruption For patients with major stroke syndrome of <8
hours’ duration and ineligible for or failing
intravenous thrombolysis
May be reasonable to perform mechanical
disruption to restore cerebral blood flow in
selected patients
Cerebral AVM
Pial AVM For patients with hemorrhage referable to the
AVM, endovascular treatment in combination
with other therapies such as surgery or
radiosurgery
May be considered as a preoperative
adjunct or palliative treatment in an effort to
prevent recurrent hemorrhage
Dural AV fistula For patients with neurological symptoms or
hemorrhage referable to the AVM, endovascular
treatment alone may be curative or may be used
in combination with other therapies such as
surgery or radiosurgery
May be considered as a preoperative
adjunct or palliative treatment in an effort to
prevent stroke or hemorrhage

SAH indicates subarachnoid hemorrhage; AVM, arteriovenous malformation.
 
 
References:

  1. Meyers PM, Schumacher HC, Higashida RT, Barnwell SL, Creager MA, Gupta R, McDougall CG, Pandey DK, Sacks D, Wechsler LR; American Heart Association. Indications for the performance of intracranial endovascular neurointerventional procedures: a scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation. 2009 Apr 28;119(16):2235-49 [Medline]
  2. Qureshi AI, Abou-Chebl A, Jovin TG. Qualification requirements for performing neurointerventional procedures: a Report of the Practice Guidelines Committee of the American Society of Neuroimaging and the Society of Vascular and Interventional Neurology. J Neuroimaging. 2008 Oct;18(4):433-47. [Medline]

Created: Nov 29, 2010

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