Neurosurgery clinics of North America
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Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical catastrophe. It affects 33,000 patients in the United States annually and has a mortality rate of 50% to 60% at 30 days. Half of the survivors are dependent. ⋯ The cost impact factor of this condition is high from a financial perspective as well as from a patient perspective. Care givers show increased morbidity when compared with the nonaffected community. Early aggressive treatment of good grade patients seems to provide the best outcome for this serious condition.
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Endovascular reperfusion therapy is evolving as a promising treatment in the setting of acute ischemic stroke. Careful patient selection and angiographic evaluation of the location and extent of occlusion are necessary for the successful management of stroke patients. ⋯ Mechanical thrombolysis is becoming an adjunctive or alternative treatment therapy via novel clot dissolution and retrieval techniques. Existing and upcoming trials are investigating the safety and efficacy of neuroendovascular therapy while attempting to expand its indications in acute ischemic stroke.
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Neurosurg. Clin. N. Am. · Oct 2009
ReviewNeuroendovascular management of carotid cavernous fistulae.
Carotid-cavernous fistulae are abnormal arterial communications within the cavernous sinus. Endovascular obliteration is the mainstay therapy for the definitive treatment of these lesions. ⋯ These include transarterial or transvenous embolization with balloons, coils, particles, or covered stents, and arterial sacrifice. The preferred technique is based on the fistula type (direct or indirect), microanatomy, chronicity, and the extent of the arterial defect.
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Neurosurg. Clin. N. Am. · Oct 2009
ReviewNeuroendovascular management of vasospasm following aneurysmal subarachnoid hemorrhage.
Cerebral vasospasm continues to be the leading treatable cause of death and disability in patients with subarachnoid hemorrhage. Transluminal balloon angioplasty has been considered a safe and effective treatment for cerebral vasospasm resistant to maximal medical treatment. However, it should be performed in a timely manner, any delays could potentially increase the risk of hemorrhagic infarct. Angioplasty in the affected territory may be of benefit in improving not only the angiographic appearance but also the ultimate outcome for the patient, if performed in a timely fashion.