RESUMEN
Neurological endovascular therapy is a discipline that has shown effectiveness and safety in the management of intracranial aneurysms, however recanalization persists as one of the most important obstacles to overcome. Precise knowledge of the anatomy and hemodynamics of the aneurysm and the parent artery as well as currently available endovascular devices, are decisive in the analysis and to design a specific treatment plan for each case. In this manner we ensure, as long as possible, success and durability of the treatment.
Asunto(s)
Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/métodos , Aneurisma Intracraneal/terapia , Embolización Terapéutica/instrumentación , Humanos , StentsRESUMEN
The success and stability of the occlusion of intracranial aneurysms can be achieved after an adequate conceptualization and implementation of current endovascular techniques, which in turn should be based on knowledge of available devices and the analysis of the specific characteristics the aneurysm and its parent artery to what we called aneurysmal complex.
Asunto(s)
Procedimientos Endovasculares/métodos , Aneurisma Intracraneal/cirugía , Humanos , Aneurisma Intracraneal/patologíaRESUMEN
OBJECT: So-called direct carotid-cavernous fistulas (CCFs) are commonly treated by detachable balloons or coils to occlude the shunt while sparing the carotid artery. Liquid embolic agents have been rarely used, and in particular, to the authors' knowledge, the use of Onyx as the sole agent has never been reported in an indexed publication. METHODS: The authors describe a case series of 5 patients with posttraumatic CCF in whom embolization with Onyx was prospectively used as the sole strategy of management. RESULTS: Complete occlusion was obtained at the end of the procedure in 4 cases, and the lesion in the remaining patient subsequently occluded at the 6-month follow-up evaluation. CONCLUSIONS: As endovascular techniques for treatment of direct CCFs continue to evolve, this novel approach with Onyx as the sole embolic material seems promising in treating these lesions.
Asunto(s)
Fístula del Seno Cavernoso de la Carótida/terapia , Dimetilsulfóxido , Embolización Terapéutica/métodos , Polivinilos , Adolescente , Adulto , Angiografía de Substracción Digital , Fístula del Seno Cavernoso de la Carótida/etiología , Fístula del Seno Cavernoso de la Carótida/patología , Angiografía Cerebral , Estudios de Cohortes , Traumatismos Craneocerebrales/complicaciones , Dimetilsulfóxido/efectos adversos , Embolización Terapéutica/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Polivinilos/efectos adversos , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Carotid atherosclerosis accounts for about 25 % of all ischemic cerebrovascular events. A thorough knowledge of the pathophysiology of the plaque and its clinical consequences are fundamental elements for a well-balanced approach of the management of the disease. The evolution of the imaging techniques allow to visualize the plaque and the analysis of its structure and characteristics. The awareness of the physiopathology and the understanding of the imaging modalities are key issues when planning the treatment of the patient.
Asunto(s)
Aterectomía , Enfermedades de las Arterias Carótidas/diagnóstico , Enfermedades de las Arterias Carótidas/cirugía , Stents , HumanosRESUMEN
Carotid endarterectomy has for long been regarded as the gold standard for the management of symptomatic atherosclerosis of the carotid bifurcation, and carotid angioplasty is merely considered a secondary alternative reserved to surgically high-risk patients. However, several studies have shown that the efficacy of carotid angioplasty has equaled that of carotid endarerectomy and additionally provides unshared advantages: local anesthesia is sufficient, the whole extracranial and intracranial carotid circulation are amenable to treatment and wound-related complications are not seen. Besides a thorough review of the main published studies comparing both techniques, we provide updated criteria for the endovascular management of carotid artery disease, discussing their benefits and limitations.