Techniques in Vascular & Interventional Radiology RSS feed: Current Issue. Interventional radiology is an area of clinical diagnosis and management that is highly technique-oriented. Therefore, the format of this quarterly journal, which combines the visual impact of an atlas with the currency of a journal, lends itself perfectly to presenting the topics. Each issue is guest edited by a leader in the field and is focused on a single clinical technique or problem. The presentation is enhanced by superb illustrations and descriptive narrative outlining the steps of a particular procedure. Interventional radiologists, neuroradiologists, vascular surgeons and neurosurgeons will find this a useful addition to the clinical literature. Techniques in Vascular and Interventional Radiology is a quarterly review publication for physicians and allied health professionals interested in image-guided minimally-invasive therapies. Its mission is to improve patient care by educating interventionalists on the latest techniques in catheter-based therapies from experts in the field. 2012 Topics , Volume 15 March Stroke Guilherme Dabus June Chronic Cerebrospinal Venous Insufficiency Gary Siskin September Balloon-occluded Transvenous Obliteration: BRTA and BATO Wael Saad December Prostate Embolization Joao Martins Pisco http://www.techvir.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Techniques in Vascular & Interventional Radiology1089-2516151March 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.techvir.com/article/PIIS1089251612000078/abstract?rss=yesEditorial Board10.1053/S1089-2516(12)00007-8Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-7iihttp://www.techvir.com/article/PIIS1089251612000091/abstract?rss=yesPrevious Topics10.1053/S1089-2516(12)00009-1Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-7iiiihttp://www.techvir.com/article/PIIS108925161200011X/abstract?rss=yesTable of Contents10.1053/S1089-2516(12)00011-XTechniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-7iiiivhttp://www.techvir.com/article/PIIS1089251611001119/abstract?rss=yesThe management of acute ischemic stroke is a dynamic process that has been changing for the past 20 years. New medications and protocols for intravenous treatment became available and are considered the standard of care since mid-1990s. This has led to a revolution where we stopped contemplating the disease to actively treat it. Amazing advances in acute stroke neuroimaging are also changing the way we approach these patients. Imaging of the core infarct and salvageable brain tissue is being used more and more often and, in the future, after it is fully validated, will probably determine how the patient presenting with acute ischemic stroke should be treated. More recently, endovascular techniques (chemical and mechanical) have gained wider acceptance and are now also considered very important tools in the management of this terrible disease. The constant improvement in device technology has reduced significantly the time necessary to recanalize a vascular territory, favorably impacting patient outcome. Also extremely important are the advances in neuro-intensive care unit care, including patient monitoring, blood pressure, and temperature and glycemic control.IntroductionGuilherme Dabus10.1053/j.tvir.2011.12.004Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-711http://www.techvir.com/article/PIIS1089251611001107/abstract?rss=yes Acute ischemic stroke (AIS) is an important public health issue with major impact on not only patients and families but also on the society as well. Among patients who suffer from AIS, those who have the event due to large-vessel occlusion are thought to have the worse outcome. Because most of the effort in endovascular treatment of AIS is aimed toward this type of stroke, it is important to understand its natural history. The goal of this manuscript was to briefly discuss the natural history of AIS due to large-vessel occlusion based on recent literature. The Natural History of Acute Ischemic Stroke Due to Intracranial Large-Vessel Occlusion: What Do We Know?Guilherme Dabus, Italo Linfante10.1053/j.tvir.2011.12.003Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-724http://www.techvir.com/article/PIIS108925161100117X/abstract?rss=yes The past decade has ushered in a refined understanding of—and commitment to—objective evidence-based practice of stroke management. Responding to the need for universal protocol-driven guidelines for stroke care, the Brain Attack Coalition published consensus statements with recommendations for primary stroke centers (Alberts MJ, et al, JAMA 283:3102-3109, 2000) and comprehensive stroke centers (Alberts MJ, et al, Stroke 36:1597-1616, 2005) in 2000 and 2005, respectively. These benchmark publications helped to define a new “standard of care” for stroke patients and laid the groundwork to establish formal certification for stroke centers. Although large randomized controlled trials evaluating the efficacy of these guidelines are currently underway, several recent reports suggest that stroke center certification may improve outcomes in patients with acute ischemic stroke. In this article, the authors briefly discuss the status of stroke center certification and the evolution of stroke systems of care. Elements of a Stroke CenterMatthew R. Reynolds, Peter D. Panagos, Gregory J. Zipfel, Jin-Moo Lee, Colin P. Derdeyn10.1053/j.tvir.2011.12.010Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-759http://www.techvir.com/article/PIIS1089251611001090/abstract?rss=yes A number of landmark trials have proven the efficacy of thrombolysis by intravenous recombinant tissue plasminogen activator in the acute phase of the ischemic stroke. Despite the recently extended time window of 4.5 hours, the number of people who are being treated in most centers is low. Several reasons seem to account for this, including poor recognition of symptoms, delays in emergency transport, low levels of public awareness, or age limits originally imposed by drug regulatory rules. Trials are ongoing to possibly extend the indications to the treatment. A major effort is to extend the time window by bridging the treatment with neuroprotective approaches, or by identifying subgroups that may particularly benefit from recanalization and reperfusion. Procedures using ultrasounds or alternative intravenous compounds are also being investigated with promising results. Current Indications and Results of Thrombolysis by Intravenous Recombinant Tissue Plasminogen ActivatorFrancesca Tari Capone, Michele Cavallari, Barbara Casolla, Francesco Orzi10.1053/j.tvir.2011.12.002Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-71018http://www.techvir.com/article/PIIS1089251611001132/abstract?rss=yes Although the non-contrast computed tomography head continues as the sole mandatory imaging technique before intravenous thrombolysis, the increased availability of advanced infarct/penumbral imaging techniques and confidence in their use have led many to adopt them into routine practice—most particularly before intra-arterial interventions. Computed tomography versus magnetic resonance-based routes to imaging the cerebral vasculature, cell death, and parenchymal perfusion have differing advantages in terms of speed, availability, exposures to contrast and radiation, sensitivity, and resolution. Continued refinement and future developments, such as the ability to quantitate perfusion, promise to lead to tailored treatment protocols that respect the individual variations in anatomy, physiology, and pathology. This should lead both to an extension of treatment to patients currently excluded by rigid time windows and the avoidance of futile therapies and their associated morbidities. Neuroimaging in Acute Stroke: Choosing the Right Patient for NeurointerventionMichael C. Hurley, Maryam Soltanolkotabi, Sameer Ansari10.1053/j.tvir.2011.12.006Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-71932http://www.techvir.com/article/PIIS108925161100120X/abstract?rss=yes Endovascular stroke therapy is an effective means of achieving reperfusion in stroke patients with proximal cerebral artery occlusions. However, current guideline recommendations express uncertainty regarding the clinical efficacy of catheter-based treatments, given the lack of supportive trial data. A critical problem is that it remains unclear which patients will benefit from endovascular therapy. As such, patient selection is likely highly variable in clinical practice. This article will review the existing data to discuss the clinical and imaging factors that are relevant to patient outcomes, and which may be used to guide endovascular treatment decisions. Anterior circulation strokes represent the primary focus of this review. Endovascular Treatment of Acute Ischemic Stroke: Current IndicationsAlbert J. Yoo, Zeshan A. Chaudhry, Thabele M. Leslie-Mazwi, Ronil V. Chandra, Joshua A. Hirsch, Ramon Gilberto González, Claus Z. Simonsen10.1053/j.tvir.2011.12.013Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-73340http://www.techvir.com/article/PIIS1089251611001181/abstract?rss=yes Recanalization rates with the administration of intravenous tissue plasminogen activator in acute ischemic stroke are low. Adjuvant endovascular techniques that achieve recanalization by direct intra-arterial (IA) delivery of thrombolytics, mechanical clot retrieval, clot aspiration, and stenting may complement intravenous pharmacotherapy. IA thrombolytics can be administered within 6 hours of symptom onset in anterior circulation strokes and within 24 hours in posterior circulation strokes. This review describes the indications, patient selection, and technique for IA administration of thrombolytics. Intra-arterial Thrombolysis: Tissue Plasminogen Activator and Other Thrombolytic AgentsEdgar A. Samaniego, Italo Linfante, Guilherme Dabus10.1053/j.tvir.2011.12.011Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-74146http://www.techvir.com/article/PIIS1089251611001156/abstract?rss=yes Acute ischemic stroke is one of the most prominent causes of death and disability in the modern world. Despite extensive research, the only Food and Drug Administration-approved pharmacologic treatment is intravenous recombinant tissue plasminogen activator (rt-PA). Although reperfusion remains the most robust predictor of clinical outcome, rt-PA has been linked to low recanalization rates in large-vessel occlusion. Endovascular techniques have been developed over past decade with several theoretic advantages over intravenous rt-PA alone, including longer treatment windows and higher recanalization rates in large-vessel occlusions. The Merci retriever thrombectomy device was approved by the Food and Drug Administration in 2004 for removing thrombus in acute ischemic stroke. In this article, we review the indications for acute stroke endovascular treatment with the Merci retriever as well as the involved techniques and the results of research studies. Acute Stroke: Techniques and Results With the Merci RetrieverAli Reza Noorian, Rishi Gupta, Raul G. Nogueira10.1053/j.tvir.2011.12.008Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-74752http://www.techvir.com/article/PIIS1089251611001144/abstract?rss=yes The Penumbra System is an endovascular mechanical thrombectomy device that uses continuous aspiration to perform recanalization of occluded intracranial vessels. The objective of this article was to provide a comprehensive overview of the data on technical and functional outcome so far published for aspiration thrombectomy and resume techniques that can be used to optimize functionality of the Penumbra System. We focus on existing clinical data as well as our institutional experience and techniques. Techniques and Results—Penumbra Aspiration CatheterAndreas S. Kreusch, Marios-Nikos Psychogios, Michael Knauth10.1053/j.tvir.2011.12.007Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-75359http://www.techvir.com/article/PIIS1089251611001193/abstract?rss=yes Recanalization rates with conventional pharmacologic thrombolysis and thrombectomy devices in the treatment of large-vessel occlusions are low. Moreover, these patients do not have favorable clinical outcomes. Better recanalization devices and approaches are needed. In this review, we describe current stents used in the intracranial circulation and their application in the treatment of acute ischemic stroke due to large-vessel occlusion. Techniques and Results: Intracranial StentingEdgar A. Samaniego, Guilherme Dabus, Italo Linfante10.1053/j.tvir.2011.12.012Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-76067http://www.techvir.com/article/PIIS1089251611001168/abstract?rss=yes Stentrievers are stent-like devices used in the treatment of acute ischemic stroke. They have demonstrated efficacy in restoring the intracranial blood flow with low procedural times. This article is a synopsis of the available devices and different techniques. An extensive review of the literature summarizing all the data that have been published demonstrating their clinical impact and complications is also presented. Use of Stentrievers in Acute Stroke: Tips, Tricks, and Current ResultsVitor Mendes Pereira, Ana Paula Narata, Ana Marcos Gonzalez, Roman Sztajzel, Karl-Olof Lovblad10.1053/j.tvir.2011.12.009Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-76877http://www.techvir.com/article/PIIS1089251611001120/abstract?rss=yes Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. Neurocritical care is essential to reduce and appropriately treat complications after endovascular procedures. Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke. Acute Stroke: Postprocedural Care and Management of ComplicationsFlávio Augusto de Carvalho, Marcelo Marinho de Figueiredo, Gisele Sampaio Silva10.1053/j.tvir.2011.12.005Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-77886http://www.techvir.com/article/PIIS1089251611001089/abstract?rss=yes Interventional neuroradiology plays a continuously expanding and exciting role in the treatment of acute stroke, as evidenced by the development of several important advances, including the advent of multiple new devices and therapies. Furthermore, guidelines regarding endovascular interventions in the setting of acute stroke have been developed and used. In addition to technological advances, the field of pharmacology in the setting of acute stroke is constantly evolving. In a rapidly expanding field, we aim to review significant recent advances related to the endovascular treatment of stroke as well as provide perspective for future directions. Past, Present, and Future Perspectives on the Endovascular Treatment of Acute Ischemic StrokeOmar M. Arnaout, Rudy J. Rahme, Tarek Y. El Ahmadieh, Salah G. Aoun, H. Hunt Batjer, Bernard R. Bendok10.1053/j.tvir.2011.12.001Techniques in Vascular & Interventional Radiology 15, 1 (2012)2012-03-01Techniques in Vascular & Interventional Radiology2012-03-01151S1089-2516(11)X0005-78792