神经介入放射学（英文影印版）

PART I

FUNDAMENTALS

CHAPTER 1

Tools of the Trade

1

J.J. Connors III, J.C. Wojak, and Z. Qian

Routine Supplies for Interventional Neuroradiology Cases Puncture Systems Hemostatic Devices Guidewires *

Neuro-Sheaths Guide Catheters * Flow Control Catheters Temporary Test Occlusion Balloon Catheters Angioplasty

Balloon Catheters Microcatheters * Atherosclerotic Microangioplasty Catheters Vasospasm Microangioplasty Cathe-

ters * Venting Catheters Temporary Stenting Catheters Snares Embolectomy Devices Commercial and Investiga-

tive Metallic Stents Particulate Embolic Agents Mechanical Embolic Agents Liquid Embolic Agents Air Filters

Microtubing Large-Bore Y Connectors Steamers * Isotonic Iso-Osmolar Nonionic Contrast Temporary Pacemakers

Vertebral Body Biopsy Needles

CHAPTER 2

Future Devices and Procedures

38

J.J. Connors ill and J.C. Wojak

Paving Stents Spherical Coils and Three-Dimensional Coils Advanced Embolic Agents Monitoring Guidewires

Microminiaturized Tools Percutaneous Dilation ofAqueductal Stenosis Alternative Inflation Methods for Angioplasty

Balloons Beta Radiation Delivery Catheter System Radioactive Stents Cutting Balloons Infiltrating Angioplasty

Balloons Multiballoon Angioplasty Systems Excimer Laser Ablation Vascular Recanalization

CHAPTER 3

Tricks of the Trade

41

J.J. Connors III and J.C. Wojak

Diamox Challenge Test How to Test a Vessel Before Embolization (Provocative Testing) How to Mix Particles How

to Mix and Use Avitene How to Load Silk for Embolization How to Use Alcohol Embolizing With Coils How to

Mount a Detachable Balloon Propping a Balloon Steering a Detachable Balloon How to Use a Snare * Preparing a

Large-Lumen Intravascular Withdrawal System for a Foreign Body How to Steam a Catheter How to Use the Intime

Catheter Steering a Flow-Directed Catheter into the Anterior Rather Than the Middle Cerebral Artery How to

Introduce a Guide Catheter Directly Through the Skin Dealing With Unwanted Hydrophilic Coating Accurate Mea-

surement of a Vessel, Stenosis, Aneurysm, or Other Structure Puncture Through a Graft Safe Catheterization of

Difficult and/or Tortuous Vessels Protective Embolization of Vital Vessels Prevention of Catheter-Induced Spasm

Spinal Angiography Carotid Compression Procedure for Carotid-Cavernous Fistulae Direct Puncture of the Carotid

Artery Useful Measurements and Conversions

CHAPTER 4

Pharmacology in Interventional Neuroradiology

59

J.C. Wojak

Embolic Agents Local Anesthetics Sedation Analgesia Anticonvulsants Antiemetics Antibiotics * Antihyper-

tensives Antiulcer Agents * Neuroprotectants Cardiovascular Agents Drugs for Functional Neurologic Testing An-

ticoagulants and Antiplatelet Drugs Vasodilators Thrombolytic Agents Miscellaneous Pharmaceuticals

CHAPTER 5

Fundamental Neurovascular Anatomy

77

J.C. Wojak

Dangerous Extracranial-Intracranial Anastomoses Persistent Primitive Anastomoses from the Anterior Circulation to

the Posterior Circulation Intrinsically Dangerous Vessels Vascular Supply to the Spinal Cord Intracranial Vascular

Territories

xviii Contents

CHAPTER 6

Neurologic Correlates of Cerebrovascular Occlusions

84

D.v. Rodriguez

Specific Vessels and Associated Findings

CHAPTER 7

General Preprocedure and Postprocedure Orders

89

J.C. Wojak

Preprocedure Orders Postprocedure Orders Additional Medications (As Needed for Specific Cases)

PART II

EMBOLIZATION

CHAPTER 8

General Principles of Embolization

93

J.J. Connors ill and J.C. Wojak

Pathologies Amenable to Embolotherapy General Technique of Embolization * Extra-Axial Tumors *

CHAPTER 9

Meningiomas

100

J.J. Connors III and J.C. Wojak

Epidemiology Radiographic Evaluation * Preoperative Embolization Inoperable Tumors

CHAPTER 10

Juvenile Nasopharyngeal Angiofibromas

121

J.J. Connors ill and J.C. Wojak

Epidemiology Clinical Presentation Pathology * Evaluation Endovascular Therapy Recurrence

CHAPTER 11

Paragangliomas

130

J.J. Connors ill and J.C. Wojak

Tympanic Paragangliomas Jugular Paragangliomas * Carotid Paragangliomas Vagal Paragangliomas Secretory Ac

tivity of Paragangliomas/Hypertensive Crisis General Goal of Endovascular Therapy of Paragangliomas Elective

Presurgical Internal Carotid Artery Occlusion *

CHAPTER 12

Tumors of the Vertebral Bodies and Other Bones

142

J.J. Connors ill and J.C. Wojak

Transarterial Vertebral Body Tumor Embolization * Percutaneous Ethanol Ablation of Intraosseous Vertebral Body He-

mangiomas Preablation Testing * Percutaneous Vertebroplasty

CHAPTER 13

Epistaxis

147

J.J. Connors III and J.C. Wojak

Rationale for the Therapeutic Approach to Epistaxis Technique of Therapy for Epistaxis

CHAPTER 14

Soft Tissue Tumoral Hemorrhage in the Head and Neck

157

J.J. Connors ill and J.C. Wojak

Rationale for Therapy Continued Bleeding from the Tumor Mass Due to Collateral Supply

CHAPTER 15

Arteriovenous Fistulae and Traumatic Vascular Lesions

160

J.J. Connors ill and J.C. Wojak

General Considerations Traumatic Head and Neck Hemorrhage * Traumatic Arteriovenous Fistulae Pseudoaneu-

rysms of Brachiocephalic Vessels Intracranial Pial Arteriovenous Fistulae (Nongalenic) Potential Complications of

Therapy of Arteriovenous Fistulae *

CHAPTER 16

Endovascular Therapy for Vertebral Artery Arteriovenous Fistulae

180

A. Ayrnard, R. Chapot) E. Houdart, A.E. Casasco, H.S. Jhaveri, D. Reizine, and J.''J. Merland

General Considerations Therapeutic Approach Outcome Conclusion

CHAPTER 17

Embolization of Spinal Vascular Malformations

186

A.E. Casasco, E. Houdart,

H.S. Jhaveri, A. Ayrnard, D. Herbreteau) J.-P. Guichard, D. Reizine) K.L. Mourier, and J.-J. Merland

General Concepts Classification General Approach to Treatment Spinal Cord Arteriovenous Malformations

Perimedullary Arteriovenous Fistulae Spinal Dural Arteriovenous Fistulae With Perimedullary Venous Drainage

Epidural Vascular Malformations Paraspinal Vascular Malformations Cobb''s Syndrome * Vertebral Hemangiomas

Spinal Cord Tumors * Conclusion

CHAPTER 18

Endovascular Therapy and Long-Term Results for Intracranial Dural Arteriovenous

Fistulae

198

C. Cognard, E. Houdart, A.E. Casasco, H.S. dhaveri, R. Chapot, and J.''J. Merland

Etiology Pathophysiology Classification According to the Type of Venous Drainage and Implications Location Ther-

apeutic Approaches Specific Treatment Considerations Relating to Location of the Fistula Spontaneous or Posttreat-

ment Modification of Venous Drainage *

CHAPTER 19

Treatment of Carotid-Cavernous Sinus Fistulae

215

Donald Larsen, Randall T. Higashida, and

J.J. Connors III

Etiology Classification Pathophysiology and Clinical Presentation History Radiographic Evaluation Treatment

Options Indirect Carotid-Cavernous Fistulae Carotid Compression Maneuver Conclusions *

CHAPTER 20

Intracranial Arteriovenous Malformations: General Considerations

227

J.J. Connors ill and

J.C. Wojak

Spetzier and Martin Grading System General Philosophy of Therapy * Theory of AVM Embolization Techniques of

Therapy Materials for Embolization Role of Embolization in Radiosurgery Technical Problems, Complications, and

Solutions in AVM Embolization *

CHAPTER 21

Intracranial Arteriovenous Malformations: The Approach

and Technique of Cyanoacrylate Embolization

240

V.A. Aletich and G.M. Debrun

Initial Evaluation Technique Illustrative Cases Risks, Potential Complications, and Solutions * Conclusion

CHAPTER 22

Ethanol Endovascular Management of Brain Arteriovenous Malformation:

Initial Experience

259

W.F.J. Yokes

Rationale for Use Concepts in Patient Management Technical Problems, Complications, and Solutions Discussion

CHAPTER 23

The Role of Embolization in Combination with Stereotactic Radiosurgery in the Management of

Pial and Dural Arteriovenous Malformations

267

B.E. Pollock, L.D. Lunsford, J.C. Flickinger,

and D. Kondziolka

Pial Arteriovenous Malformations Dural Arteriovenous Malformations

CHAPTER 24

Intracranial Aneurysms: General Considerations

276

J.J. Connors ill and J.C. Wojak

Incidence and Natural History Imaging History of Endovascular Therapy Current Endovascular Therapies

Management of Therapeutically Challenging Aneurysms Hazards of Aneurysm Embolization Potential Advances in

Intracranial Aneurysm Treatment

CHAPTER 25

Detachable Coil Embolization of Intracranial Aneurysms

294

M.E. Cronquist and J. Moret

Pretherapeutic Evaluation and Indications Limitations in and Contraindications to Endovascular Therapy Technical

Devices Procedure Complications and Their Management Interval Angiography and Follow-Up

xx Contents

PART III

MISCELLANEOUS INTERVENTIONAL NEURORADIOLOGIC PROCEDURES

CHAPTER 26

Current Management of Cervicofacial Superficial Vascular Malformations and

Hemangiomas

317

D. Herbreteau, A. Ayrnard, H.S. Jhaveri, R. Chapot, A.E. Casasco, S. Slaba,

E. Houdart, and J.''J. Merland

Hemangiomas Vascular Malformations

CHAPTER 27

Management of Extracranial Head and Neck and Paraspinal Vascular

Malformations

327

W.F.J. Yakes

General Concepts of Therapy Classification of Hemangiomas and Vascular Malformations * Rationale for Therapy Em-

bolic Agents Initial Evaluation Concepts in Patient Management Complications *

CHAPTER 28

Percutaneous Direct Embolization of Head and Neck Vascular Tumors

338

A.E. Casasco,

E. Houdart, H.S. Jhaveri, D. Herbreteau, A. Ayrnard, B. George, M. Wassef, P.T. Ba Huy, and J.-J. Merland

General Technique Strategy- of Treatment of Specific Tumors Pre-Embolization Patient Preparation and Percutaneous

Puncture Techniques Postembolization Care and Follow-Up Results Technical Problems, Complications, and Solu-

tions Conclusion

CHAPTER 29

Percutaneous Vertebroplasty: Indications, Technique, and Complications

346

c. Depriester,

H. Deramond, P. Toussaint, H.S. Jhaueri, and P. Galibert

Pathologies Amenable to Treatment Materials and Devices Preprocedure Orders * Description of Procedure * Post-

procedure Orders Technical Incidents and Complications

CHAPTER 30

A Treatment for Head and Neck Cancer by Direct Arterial Infusion

358

C.w. Kerber,

W.H.M. Wong, and K.T. Robbins

Background and History Theory General Approach to Evaluation and Treatment * Technique Results Technical

Pitfalls, Complications, and Solutions Summary

CHAPTER 31

Intra-Arterial Chemotherapy for Central Nervous System Tumors

368

Jacques Chiras

Background Pharmacologic and Experimental Data Techniques of Infusion Conclusion

CHAPTER 32

Interventional Neuroradiologic Procedure for Wada Testing

372

J.J. Connors ill and

J.C. Wojak

Applications Procedure False-Positive Wada Test

CHAPTER 33

Intracarotid Amobarbital (Wada) Test: Neurology Perspective

374

Piotr Olejniczak and

Bruce Fisch

Procedure Applications

CHAPTER 34

Temporary Test Occlusion of the Internal Carotid Artery

377

J.J. Connors ill

Indications Tools Technique Variations What Is a Temporary Test Occlusion Failure? Technical Problems, Com-

plications, and Solutions False-Negative and False-Positive Test Results

CHAPTER 35

Permanent Occlusion of the Internal Carotid Artery

390

J.J. Connors ill

Rationale for Procedure Technical Theory Specific Technique Single-Photon Emission Computed Tomography Follow-

ing Balloon Occlusion Alternative TechniqueFibered Coils Technical Problems, Complications, and Solutions

CHAPTER 36

Endovascular Test and Permanent Occlusion of Extracranial and Intracranial Cerebral Vessels:

Indications, Techniques, and Management

394

J.N. Vallee, A. Ayrnard, A.E. Casasco,

H.S. Jhaveri) E. Houdart, and J.''J. Merland

General Considerations Internal Carotid Artery Common Carotid Artery Vertebral Artery Intradural Vessels

Complications Follow-Up * Conclusion

CHAPTER 37

Endovascular Treatment of Traumatic Lesions in Supra-Aortic Vessels With

Stent-GraftS

408

J.C. Parodi and C.J. Schonholz

History * General Approach Results Complications Follow-Up Conclusions

CHAPTER 38

Inferior Petrosal Sinus Sampling

411

J.J. Connors ill and J.C. WoJak

Rationale for Procedure Technique of Sampling Technical Problems, Complications, and Solutions

CHAPTER 39

Nerve Blocks and Discectomy

421

J.C. Wojak and J.J. Connors ill

Nerve Blocks Discectomy

CHAPTER 40

Percutaneous Treatment of Cervical and Lumbar Disc Herniations

424

J.G. Theron

Treatment Options Indications Choice of Procedure Pretherapeutic Consultation Technique Technical Problems,

Complications, and Solutions Conclusion

PART IV

BRACHIOCEPHAUC ANGIOPLASTY AND STENTING

CHAPTER 41

General Concepts of Brachiocephalic Angioplasty for Atherosclerosis

431

J.J. Connors ill

Importance and Implications of Degree of Stenosis Ongoing Clinical Trials Locations of Atherosclerotic Brachiocephalic

Disease General Theory of Angioplasty and Pathophysiologic Response Angioplasty and Fibrinolysis Restenosis

CHAPTER 42

General Technique of Extracranial Angioplasty and Stenting

438

J.J. Connors ill

Tools for Extracranial Angioplasty and Stenting Preliminary Evaluation Indications Contraindications Preproce-

dure Preparation Procedural Technique for Extracranial Angioplasty Postprocedure Care Probucol Follow-up

CHAPTER 43

General Considerations for Endovascular Therapy of the Extracranial Internal Carotid Artery

at the Bifurcation

442

J.J. Connors ill

Natural History of the Disease Carotid Endarterectomy Advantages of Carotid Angioplasty * Disadvantages and Risks

of Carotid Angioplasty Rationale for Stent Use Cerebral Protection During Internal Carotid Angioplasty Distal

Perfusion During Angioplasty Asystole After Carotid Stenting The Future of Endovascular Carotid Artery Therapy

CHAPTER 44

Cervical Carotid Angioplasty and Stent Placement for Atherosclerosis

456

V. Wadlington,

J. Yadau, J. Vitek, M. Parks) S. lyer) and G. Roubin

Patient Selection Angioplasty Risks Surgical Risks * Preparation * Angioplasty and Stent Procedure Postangi-

opIasty/Stenting Results Postangioplasty Management Follow-Up Conclusions

CHAPTER 45

Protected Angioplasty and Stenting of Atheroscierotic Stenosis

at the Carotid Artery Bifurcation

466

J.G. Theron

Evolution of the Techniques of Protected Angioplasty and Protected Stenting Role of Digitized Parenchymography in

Patient Evaluation Current Periprocedural Medication Protocol Complications and Solutions

CHAPTER 46

Current Status and Future Possibilities of Balloon Angioplasty in the Carotid

Artery

473

R. Rachel

Balloon Angioplasty as a Controlled Injury * Indications for Carotid Angioplasty Without Stenting (Conventional) Pre-

therapeutic Diagnostic Methods Patient Preparation Materials Method Postprocedure Management Results

Cerebral Protection * To Stent or Not to Stent

CHAPTER 47

Other Extracranial Locations Amenable to Angioplasty and Stenting

484

J.J. Connors ill

Origin of the Left Common Carotid Artery from the Aorta Innominate Artery Subclavian Artery Cervical Carotid

Artery Other Than at the Bifurcation Vertebral Artery Origin

CHAPTER 48

Intracranial Angioplasty

500

J.J. Connors ill

General Considerations Location of Intracranial Atherosclerotic Disease Rationale for Treatment of Intracranial Steno-

ses Technique of Elective Intracranial Angioplasty Strategy and Technique of Penetrating a Total Intracranial Vascular

Occlusion With Downstream Ischemia Complications of Intracranial Angioplasty and How to Avoid Them

CHAPTER 49

Surgical Alternatives to Interventional Neuroradiology

555

J.R. Tompkins and R Culicchia

History Indications for Cerebral Revascularization Extracramal-intracranial Surgical Revascularization Operative

Procedures * Results Postoperative Care Conclusions

CHAPTER 50

Clinical Applications of Intravascular Ultrasound

561

S.P. Jain and S.R. Ramee

Currently Available Devices * New Devices Ultrasound Image Interpretation Reproducibility Safety Issues Limi-

tations Clinical Utility of Intravascular Ultrasound Conclusions

PARTY

POSTSUBARACHNOID HEMORRHAGE VASOSPASM

CHAPTER 51

Endovascular Therapy of Postsubarachnoid Hemorrhage Vasospasm

581

J.J. Connors ill

and J.C. Wojak

Evaluation of Intracranial Vasospasm Radiographic Manifestations Therapeutic Options

CHAPTER 52

Medical Management of Vasospasm and Hemodynamic Alterations

in the Neurosurgical ICU

602

C. Paoletti, C. Dematons, C. Bellec, J.L. Raggueneau, D. Payen de la

Garanderie, L. Do, G. Lot, B. George, J. Cophignon, and J.-J. Merland

Postembolization Care After Aneurysmal Subarachnoid Hemorrhage Monitoring and Care After Balloon Occlusion of

the Internal Carotid Artery

PART VI

EMERGENCY TREATMENT OF ACUTE ISCHEMIC STROKE

CHAPTER 53

General Considerations in Emergency Stroke Therapy

613

J.J. Connors ill and J.C. Wojak

History * Rationale for Emergency Cerebral Revascularization

CHAPTER 54

Medical Aspects of Cerebral Ischemia

616

L.A. Weisberg

Risk Factors for Ischemic Stroke Neuroloc Risk Factors for Stroke Diagnostic and Treatment Strategies Manage-

ment of the Patient With Transient Ischemic Attacks Cerebral Blood Flow and Metabolism Management of Acute

Cerebral IschemiCHAPTER 55

Cerebral Protection

626

J.C. Wojak

Barbiturate Therapy for Pre-Emptive Cerebral Protection Hypothermia

CHAPTER 56

Current Directions in Emergency Stroke Therapy

629

J.J. Connors ill and J.C. Wojak

Early Results of Neuroprotectant Agent Trials Fibrinolytic Agents Results of Early Intravenous Fibrinolytic Thera-

pies National Institute of Neurological Disorders and Stroke Tissue Plasminogen Activator Stroke Trial Results of

Early Intracranial Local Intra-arterial Fibrinolysis Ongoing Local Intra-arterial Fibrinolysis Trials Retrograde Venous

Neuroperfusion Hyperbaric Oxygen Hypothermia

CHAPTER 57

Radiology of Emergency Stroke Therapy

644

P. Mohanakrishnan, J.J. Connors ill, and

J.C. Wojak

Initial Computed Tomography Scan Follow-Up Computed Tomography Scan Magnetic Resonance Imaging Angiogra-

phy

CHAPTER 58

Strategic Considerations Concerning Emergency Stroke Treatment

650

J.J. Connors ill and

J.C. Wojak

General Considerations Regarding Fibrinolysis Rationale for Intravenous Versus Intra-Arterial Fibrinolytic Therapy

Timing of Therapy Time Versus Diagnostic Information Heart Versus Brain (Rationale for Different Therapies for

Coronary and Cerebral Vascular Occlusions) The Need to Reestablish Flow: Mechanical Versus Fibrinolytic Means

Factors Affecting Success of Fibrinolytic Therapy for Acute Stroke Factors Associated With Intraparenchymal Hema-

toma and Poor Outcome Other Predictors of Poor Outcome Optimal Emergency Stroke Therapy

CHAPTER 59

Specific Stroke Situations, Territories, and Guidelines for Therapy

2

J.J. Connors ill and

J.C. Wojak

Vertebrobasilar Stroke Anterior Circulation Stroke Dural Sinus Thrombosis Treatment of a Stroke During or Subse-

quent to an Angiographic Procedure

CHAPTER 60

Specific Technical Procedure of Emergency Intracranial Fibrinolysis

751

J.J. Connors ill and

J.C. Wojak

Getting Started Dose of Heparin Choice of Microcatheter Microcatheter Tip and Guide Catheter Localization Es-

tablishing Antegrade Flow Dose of Fibrinolytic Agent Choice of Contrast Material Dealing With Resistant Throm-

bus Chasing the Clot When to Stop Postprocedure Management Aspirin and Acute Stroke Therapy ReoPro

(abciximab) and Acute Stroke Therapy

CHAPTER 61

Technique of Superselective Intraophthalmic Artery Fibrinolytic Therapy Using Urokinase for

Central Retinal Vein Occlusion

756

J.N. Vallee, H.S. Jhaueri, M. Tovi, P.Y. Santiago, P. Paques,

A. Gaudric, and J.-J. Merland

Inclusion Criteria Exclusion Criteria Technique Results * Conclusion

CHAPTER 62

Management of Intracranial Hemorrhage During Thrombolysis

759

J.C. Wojak

CHAPTER 63

Treatment and Prevention of Acute Ischemic Stroke by Endovascular Techniques:

A Network-Based Community Model

760

B.L. Berger and A.S. Callahan ill

Background Screening Acute Treatment Results Aftercare Technical Problems, Complications, and Solu-

tions Benefits of a Dedicated Endovascular Service Referrals Future Trends

PART VII

COMPLICATIONS OF INTERVENTIONAL NEURORADIOLOGIC PROCEDURES AND THEIR

TREATMENT

CHAPTER 64

Problems, Complications, and Solutions in Embolization

768

J.J. Connors ill and J.C. Wojak

Microparticulate Pulmonary Embolism Cranial Nerve Damage Cardiopulmonary Collapse After Ethanol Emboliza-

tion Tissue Necrosis Coil Malposition Balloons Postembolic Syndrome Hypertensive Crisis Normal Perfusion

Pressure Breakthrough Failure of Residual Trunk Patency: Retrograde Thrombosis Catheter Occlusion Problems

Associated With Flow-Directed Catheters

CHAPTER 65

Rupture of a Vessel, Aneurysm, or Arteriovenous Malformation

775

J.J. Connors ill and

J.C. Wojak

Intracranial Vascular Perforation Ruptured Arteriovenous Malformation Aneurysm Rupture

CHAPTER 66

Other Problems, Complications, and Solutions

777

J.J. Connors ill and J.C. Wojak

Urokinase Chills Broken Catheter Intraprocedural Vasospasm Dissection Clot Stroke on the Table Cervical

Radiculopathy and Peripheral Neuropathy

Index

783