The Rationale Behind Transcirculation Neuroendovascular Interventions: Literature Review Through a Case-Series Approach.


Journal

Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417

Informations de publication

Date de publication:
01 04 2023
Historique:
received: 21 05 2022
accepted: 20 09 2022
pubmed: 27 1 2023
medline: 21 3 2023
entrez: 26 1 2023
Statut: ppublish

Résumé

With the development of advanced endovascular techniques and materials, neurointerventionalists can perform challenging and complex cases that were previously difficult to perform. Transcirculation approaches could be a useful tool used in complicated cases, providing access to the target vessel, through the contralateral or opposite circulation, when anterograde access is difficult or nonachievable. To retrospectively review cerebrovascular interventions performed through a transcirculation approach performed by staff at our Institution. English-language studies, published until August 2022, reporting transcirculation interventions in the cerebrovascular circulation were retrospectively collected. Type of intervention, number of cases, rationale, and complications were analyzed. Furthermore, similar cases performed by staff currently at our institution were also reviewed and described. Including our cases, a total of 273 transcirculation treatment approaches have been reported. Intracranial aneurysm embolization, stroke thrombectomies, intra-arterial ophthalmic chemotherapy, arteriovenous malformationss, arteriovenous fistulas embolizations, and intracranial angioplasty and stenting are common indications. Reason for using a retrograde approach were stent/balloon-assisted coiling of wide neck aneurysm in 116 cases, difficult angulation of branch in 91 cases, occlusion of parent vessel in 55 cases, and bailout/other in 11 cases. Transcirculation approaches can be considered for cases where conventional anterograde treatment options are not feasible or as a bailout strategy in failed or complicated treatment attempts. They represent a strategy to consider when facing challenging cases, and if performed by experienced and dedicated neurointerventionalists, they can represent a safe alternative.

Sections du résumé

BACKGROUND
With the development of advanced endovascular techniques and materials, neurointerventionalists can perform challenging and complex cases that were previously difficult to perform. Transcirculation approaches could be a useful tool used in complicated cases, providing access to the target vessel, through the contralateral or opposite circulation, when anterograde access is difficult or nonachievable.
OBJECTIVE
To retrospectively review cerebrovascular interventions performed through a transcirculation approach performed by staff at our Institution.
METHODS
English-language studies, published until August 2022, reporting transcirculation interventions in the cerebrovascular circulation were retrospectively collected. Type of intervention, number of cases, rationale, and complications were analyzed. Furthermore, similar cases performed by staff currently at our institution were also reviewed and described.
RESULTS
Including our cases, a total of 273 transcirculation treatment approaches have been reported. Intracranial aneurysm embolization, stroke thrombectomies, intra-arterial ophthalmic chemotherapy, arteriovenous malformationss, arteriovenous fistulas embolizations, and intracranial angioplasty and stenting are common indications. Reason for using a retrograde approach were stent/balloon-assisted coiling of wide neck aneurysm in 116 cases, difficult angulation of branch in 91 cases, occlusion of parent vessel in 55 cases, and bailout/other in 11 cases.
CONCLUSION
Transcirculation approaches can be considered for cases where conventional anterograde treatment options are not feasible or as a bailout strategy in failed or complicated treatment attempts. They represent a strategy to consider when facing challenging cases, and if performed by experienced and dedicated neurointerventionalists, they can represent a safe alternative.

Identifiants

pubmed: 36701756
doi: 10.1227/ons.0000000000000540
pii: 01787389-202304000-00003
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

357-367

Informations de copyright

Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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Auteurs

Marco Colasurdo (M)

Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA.

Gautam Edhayan (G)

Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA.

Alaha Al Taweel (A)

Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA.

Maggie Barghash (M)

Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA.

Peter Kan (P)

Department of Neurosurgery, The University of Texas Medical Branch, Galveston, Texas, USA.

Karthikram Raghuram (K)

Department of Radiology, Division of Neuroradiology, The University of Texas Medical Branch, Galveston, Texas, USA.

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