Neck >4mm Indication Giant aneurysm Recanalization post embo Inverter direction Recanalization.. post clipping ‘’blister like’’.[r]
(1)Overview about Neuro -Interventional Radiology
(2)Content
• Neuro -Endovascular intervention
– Aneurysm embolization – AVM
– CCF – Carotid cavernous fistula – DAVF – Dural arterio venous fistula – Throbectomy
(3)Neuro-intervention • Aneurysm
– Embolization with coils
– Balloon assisted coil embolization (BACE) – Stent assisted coil embolization (SACE) – Flow – diverter (pipeline/silk stent)
(4)(5)(6)✓ Less invasive
(7)Endovascular embolization
Coils 360o, 3D, 2D, Hydrocoils, coils VFC, coils 20 penumbra…
(8)Indication: Narrow or medium neck Need to finish early the procedure
(9)Coiling
(10)Neuro-intervention
Coiling
(11)(12)(13)(14)Neuro-intervention
(15)Neuro-intervention
Pre-procedure
Double BACE
(16)(17)(18)(19)(20)(21)Flow diverter
(22)Objectiv of FD
• Disruption of blood flow: stagnation of blood inside aneurysm, thrombosis progressive
(23)(24)(25)Neck >4mm Indication Giant aneurysm Recanalization post embo Inverter direction Recanalization
post clipping ‘’blister like’’
(26)Flow diverter- Silk Stent
12 months post Stenting
Neuro-intervention
(27)(28)(29)(30)(31)(32)(33)Parent artery occlusion
(34)(35)(36)AVM não
• Xuất huyết nội sọ biểu lâm
sàng thường gặp gây hậu nặng nề
• Gặp khoảng 2% xuất huyết nội sọ
• Chiếm từ 30 % - 82% số AVM não
• Nguy chảy máu theo năm AVM chưa vỡ khoảng 2% - 4%,
(37)AVM
Neuro-chirurgy
(38)EVT technique
• Micorcatheter:
(39)• Embolization material
• Cyanoacrylat (histoacryl) first used in 1970 Depend on mixing rate, only one feeders for each time, short time…
(40)Neurointervention
• Arteriovenous malformation (AVM): arterial way
(41)• Material: Onyx, Hystoacryl
(42)- AVM: Venous approach
Male 12yo, AVM 1st embolization by
arterial way
After 1st 2nd
After 2nd
(43)(44)(45)Ca minh họa 2
• Nữ 34 t
• Nhập viện đau đầu động kinh • Khám:
• Tỉnh, G15đ
• Khơng có thiếu hụt thần kinh khu trú
(46)Spetzler-Martin: điểm
(47)Chụp mạch
(48)(49)(50)(51)Ca minh họa 3
• Nam 25 t
• Nhập viện đau đầu đột ngột giảm ý thức • Khám:
• Hơn mê, G10đ • Yếu ½ người T
(52)(53)(54)Chụp mạch
(55)Chụp mạch
(56)Chụp mạch
(57)(58)(59)Tỉnh, G15đ
(60)(61)53 YO, male, ischemia stroke at 4th hours
Completed occlusion of left ICA and MCA
Neuro-intervention
(62)Totally recanalization (TICI 3) at the end of procedure
DSA
Thrombus retrieve
(63)After months, mRS = 1
(64)(65)Neuro-intervention
(66)(67)(68)(69)(70)(71)(72)Neuro-intervention
• Dural Arteriovenous Fistular (DAVF)
– Arterial approach
• Particles (PVA)
(73)Neuro-intervention • DAVF
28Y female
Progressive weakness limbs. DAVF - Type V
(74)Neuro-intervention
• Dural Arteriovenous Fistular (DAVF)
– Venous approach
• Coils
(75)Arterial approach
(76)(77)Venous approach
(78)(79)Cavernous sinus dural arteriovenous fistula Pre embolization
(80)(81)(82)(83)Neuro-intervention
• Chronic stenosis of carotid arteries
Stenosis >70 % at the proximal of left ICA
(84)Neurointervention
Angioplasty and Stenting of intracranial arterial stenosis
(85)