Handbook of Cerebrovascular Disease and Neurointerventional Technique (Contemporary Medical Imaging)
Mark R. Harrigan
Format: PDF / Kindle (mobi) / ePub
Fully revised and updated, the Handbook serves as a practical guide to endovascular methods and as a concise reference for neurovascular anatomy and published data about cerebrovascular disease from a neurointerventionalist’s perspective. Divided into three parts, the book covers:
Fundamentals of neurovascular anatomy and basic angiographic techniques;
Interventional Techniques and endovascular methods, along with useful device information and tips and tricks for daily practice;
Specific Disease States, with essential clinical information about commonly encountered conditions.
New features in the 2nd Edition include:
Global Gems that illuminate aspects of the field outside the United States;
Angio-anatomic and angio-pathologic image correlates;
Newly released clinical study results influencing neurointerventional practice;
Information on emerging technologies in this rapidly advancing field.
The Handbook is a vital resource for all clinicians involved in neurointerventional practice, including radiologists, neurosurgeons, neurologists, cardiologists, and vascular surgeons.
origin of the pericallosal and callosomarginal arteries (Fig. 1.27). Other authors have further subdivided the distal ACA into A4 and A5 segments;79, 172 in this system, the A3 segment is defined as the part of the ACA that extends around the genu of the corpus callosum, and the A4 and A5 segments comprise the part of the ACA that travels posteriorly over the corpus callosum. The A4 and A5 segments are separated by the coronal suture.172 The distal ACA branches have extensive anastomoses with
placing a guide catheter in the internal carotid artery or vertebral artery. The intervention phase involves placement of a microcatheter in the aneurysm and deployment of the coils, as well as adjunctive techniques such as stent-assisted or balloon-assisted coiling. 18.104.22.168. Awake or asleep? Some operators prefer to use general anesthesia for aneurysm cases, whereas others prefer to do them with the patient awake. Each approach has advantages. Coiling with the patient awake, permits
in a bow, if not too careful. When nearing the end of coiling an aneurysm, the microcatheter can be turned to pack areas still patent with small ultrasoft coils. After reaching the desired packing density in the aneurysm, you need to remove the microcatheter. As with any tightly curved microcatheter, it is desirable to pull the catheter out of the aneurysm over a guidewire, to avoid dragging a loop of coil with the angled tip out into the parent artery. 2. Microwires (a) A variety of microwires
atraumatic to the vessel walls. – Best suited for uncomplicated vessel anatomy (tends to follow the straightest vessel). ● Synchro®-14 0.014 inch (Boston Scientific, Inc., Natick, MA) – Very soft, flexible distal tip, good for navigation into small aneurysms or through difficult anatomy. – “Supreme torque control.” 3. Coils (a) A dizzying array of coils are on the market, varying in size, shape, design, stiffness, presence or absence of “bioactive” material, and detachment systems. Firm,
construct of coils has been created, additional filling and finishing coils can be safely inserted without inflating the balloon. INTRACRANIAL ANEURYSM TREATMENT 5.2. Device selection 161 Fig. 5.8 Balloon remodeling technique. A temporary balloon inflated adjacent to a widenecked aneurysm (A) permits placement of a framing coil, which “ovalizes” the aneurysm dome and allows packing with additional coils (B–C). The presence of the balloon forces the coils into a shape that they would not