Fortschritte in der interventionellen Neuroradiologie

P. Gölitz; A. Dörfler

doi:10.1055/s-0038-1628409

Nervenheilkunde, Table of Contents

Nervenheilkunde 2011; 30(09): 657-662
DOI: 10.1055/s-0038-1628409

Update Neurologie

Schattauer GmbH

Fortschritte in der interventionellen Neuroradiologie

Ein UpdateAdvances in interventional neuroradiologyan update

P. Gölitz

¹Abteilung für Neuroradiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg

,

A. Dörfler

¹Abteilung für Neuroradiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg

› Author Affiliations

Abstract

Zusammenfassung

In der Neuroradiologie ergeben sich aufgrund technischer Neuerungen Fortschritte in den Interventionen mit Relevanz für den klinischen Alltag. In der Akuttherapie des Schlaganfalls kommen vermehrt endovaskuläre Behandlungsverfahren zum Einsatz, durch die deutlich höhere Rekanalisationsraten als bei alleiniger intravenöser Lyse erzielt werden. Für die Behandlung extrakranieller Gefäßstenosen gibt es Hinweise, dass das Karotisstenting in manchen Fällen eine Therapiealternative zur Operation darstellt. Ausgewählte intrakranielle Gefäßstenosen sind risikoarm und effizient durch PTA und Stentimplantation auf endovaskulärem Weg behandelbar. Im nicht invasiven Monitoring von möglichen Reststenosen sind Angiografiesysteme mit Flachbilddetektoren in Kombination mit einer intravenösen Kontrastmittelgabe hilfreich. In der Aneurysmatherapie werden zunehmend Stents mit besonderer Oberflächenstruktur (Flow Diverter) zur Behandlung komplexer zerebraler Aneurysmen eingesetzt. Breitbasige Aneurysmen können mit der Ballon-remodeling-Technik behandelt werden. Durch den Einsatz von Flüssigembolisaten und speziellen Mikrokathetern hat sich die Verschlussrate von arteriovenösen Malformationen verbessert.

Summary

In acute stroke therapy endovascular treatment procedures are increasingly applied, which lead to significant higher recanalization rates than intravenous lysis. For treatment of extracranial vessel stenoses carotid stenting emerged in comparative studies as an effective therapeutic option to surgery in selected cases. Also selected intracranial vessel stenoses can be treated low-risk and efficient by PTA and stent deployment by the endovascular way. In combination with intravenous contrast agent administration flatpanel detector angiography systems are helpful for the non invasive monitoring of possible restenoses. In aneurysm therapy increasingly stents with special surface structure, flow diverter, are used for treatment of complex cerebral aneurysms. Broad based aneurysms can be treated by balloon-remodeling technique. By using liquid embolic agents and special microcatheters the occlusion rate of arteriovenous malformations has improved.

Schlüsselwörter

Neuroradiologie - endovaskuläre Interventionen - zerebrovaskuläre Erkrankungen

Keywords

Neuroradiology - endovascular interventions - cerebrovascular diseases

Full Text

References

Literatur
1 Benes V. et al. Endovascular coiling in 131 patients with low complication rate justifies treating most unruptured intracranial aneurysms. Cen Eur Neurosurg 2010; 71: 1-7.
2 Bose A. et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 2007; 38: 1531-1537.
3 Bose A. et al. The Penumbra System: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol 2008; 29: 1409-1413.
4 Brott et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363: 11-23.
5 Castaño C. et al. Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke 2010; 41: 1836-40.
6 Cekirge HS. et al. HyperForm balloon remodeling in the endovascular treatment of anterior cerebral, middle cerebral, and anterior communicating artery aneurysms: clinical and angiographic followup results in 800 consecutive patients. J Neurosurg. 2010 [Epub ahead of print].
7 Chimowitz MI. et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005; 352: 1305-1316.
8 del Zoppo G. et al. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. PROACT Investigators. Prolyse in Acute Cerebral Thromboembolism. Stroke 1998; 29: 4-11.
9 Deshmukh VR. et al. Intra-arterial thrombolysis for acute ischemic stroke: preliminary experience with platelet glycoprotein IIb/IIIa inhibitors as adjunctive therapy. Neurosurgery 2005; 56: 46-54.
10 Ederle J. et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 2010; 375: 985-997.
11 Halliday A. et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 2010; 376: 1074-1084.
12 Joo SW. et al. What is the significance of a large number of ruptured aneurysms smaller than 7 mm in diameter?. J Korean Neurosurg Soc 2009; 45: 85-9.
13 Katsaridis V, Papagiannaki C, Aimar E. Curative embolization of cerebral arteriovenous malformations (AVMs) with Onyx in 101 patients. Neuroradiology 2008; 50: 589-97.
14 Lee KY. et al. Early recanalization after intravenous administration of recombinant tissue plasminogen activator as assessed by pre- and post-thrombolytic angiography in acute ischemic stroke patients. Stroke 2007; 38: 192-3.
15 Loh Y, Duckwiler GR. Onyx trial investigators. A prospective, multicenter, randomized trial of the Onyx liquid embolic system and N-butyl cyanoacrylate embolization of cerebral arteriovenous malformations. Clinical article. J Neurosurg 2010; 113: 733-41.
16 Lubicz B. et al. Balloonassisted coiling of intracranial aneurysms is not associated with a higher complication rate. Neuroradiology 2008; 50: 769-776.
17 Lubicz B. et al. Flow-diverter stent for the endovascular treatment of intracranial aneurysms: a prospective study in 29 patients with 34 aneurysms. Stroke 2010; 41: 2247-53.
18 Lutsep L, Rymer MM, Nesbit GM. Vertebrobasilar revascularization rates and outcomes in the MERCI and multi-MERCI trials. J Stroke Cerebrovasc Dis 2008; 17: 55-7.
19 Maimon S. et al. Brain arteriovenous malformation treatment using a combination of Onyx and a new detachable tip microcatheter, SONIC: short-term results. AJNR Am J Neuroradiol 2010; 31: 947-54.
20 Memon MZ. et al. Safety and feasibility of intraarterial eptifibatide as a revascularization tool in acute ischemic stroke. J Neurosurg. 2010 [Epub ahead of print]..
21 Mohr JP. et al. The ARUBA trial: current status, future hopes. Stroke 2010; 41: e537-40.
22 Mounayer C. et al. Nidal embolization of brain arteriovenous malformations using Onyx in 94 patients. AJNR Am J Neuroradiol 2007; 28: 518-23.
23 Molyneux AJ. et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet Neurol 2002; 360: 1267-1274.
24 Molyneux AJ. et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet Neurol 2005; 366: 809-817.
25 Molyneux AJ. et al. Risk of recurrent subarachnoid hemorrhage, death, or dependence, and standardized mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009; 09: 427-433.
26 Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 2009; 40: 2761-2768.
27 Ringleb PA. et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet Neurol 2006; 368: 1239-1247.
28 Roth C. et al. Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke 2010; 41: 2559-67.
29 Scott RB. et al. Improved cognitive outcomes with endovascular coiling of ruptured intracranial aneurysms: neuropsychological outcomes from the International Subarachnoid Aneurysm Trial (ISAT). Stroke 2010; 41: 1743-7.
30 Seifert M. et al. Combined interventional stroke therapy using intracranial stent and local intraarterial thrombolysis (LIT). Neuroradiology. 2010 [Epub ahead of print].
31 Shapiro M. et al. Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 2008; 29: 1777-81.
32 Stingele R. et al. Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study. Lancet Neurol 2008; 07: 216-222.
33 Struffert et al. Optimized intravenous Flat Detector CT for non-invasive visualisation of intracranial stents: first results. Eur Radiol. 2010 [Epub ahead of print]..
34 Struffert et al. Whole brain perfusion imaging by flat detector computed tomography in comparison to conventional multislice perfusion CT: initial results. AJNR Am J Neuroradiol 2010; 31: 1462-1469.
35 Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. International Study of Unruptured Intracranial Aneurysms Investigators. N Engl J Med 1998; 339: 1725-1733.
36 Wanke I. et al. Treatment of wide-necked intracranial aneurysms with a self-expanding stent: midterm results. Zentralbl Neurochir 2005; 66: 163-169.