Rangel-Castilla / Siddiqui / Levy Video Atlas of Neuroendovascular Procedures

1. Auflage 2020
ISBN: 978-1-63853-665-9
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 540 Seiten, ePub

Unlike traditional textbooks that detail natural history, physiology, and morphology, presents basic and complex neuroendovascular procedures and cases with concise text and videos. Renowned neuroendovascular surgeons Leonardo Rangel-Castilla, Adnan Siddiqui, Elad Levy, and an impressive group of contributors have compiled the quintessential neuroendovascular resource. Organized into eight major subtopic sections, this superb video atlas covers a full spectrum of endovascular approaches to diagnose and treat intra- and extracranial neurovascular disease.

The book starts with a section on vascular access and concludes with endovascular complications and management. Forty chapters includes succinct summaries, scientific procedural evidence, the rationale for endovascular intervention, anatomy, required medications, device selection, avoiding complications, and managing potential problems that can arise during procedures. The image-rich clinical cases feature insightful firsthand knowledge and pearls.

Key Features

• More than 1,000 relevant, high quality neuroimaging findings and artist illustrations enhance understanding of impacted anatomy and approaches
• Specific techniques and key steps are brought to life through more than 140 outstanding videos narrated by highly experienced endovascular neurosurgeons — conveniently accessible via smart phones or tablets using QR technology
• Essential diagnostic procedures such as cerebral and spinal angiography, cerebral venogram, and balloon test occlusion
• Complex neuroendovascular procedures including various angioplasty and stenting approaches for extracranial vessel disease, carotid and vertebral arteries, and venus sinus; thrombectomy procedures to treat acute ischemic stroke; and coiling, flow diversion, and embolization techniques for intracranial aneurysms, brain/spinal AVMs and fistulas, and select CNS and extracranial tumors

The content-rich reference is a must-have for all resident and veteran neurosurgeons, interventional radiologists, and neurologists. Learn to safely perform a wide array of cutting-edge neuroendovascular procedures — from access to closure — and achieve improved outcomes for your patients.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

Autoren/Hrsg.

Rangel-Castilla, Leonardo

Siddiqui, Adnan H.

Levy, Elad I.

Lanzino, Giuseppe

Hopkins, L. Nelson

Davies, Jason

Nelson, L.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Neurochirurgie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Neurologie, Klinische Neurowissenschaft
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Bildgebende Verfahren, Nuklearmedizin, Strahlentherapie Nuklearmedizin, PET, Radiotherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Kardiologie, Angiologie, Phlebologie

Inhaltsverzeichnis

Part I Vascular Access
1 Femoral Artery Access and Closure
2 Femoral Vein Access
3 Brachial Artery Access
4 Radial Artery Access
5 Direct Carotid Artery Access
Part II Diagnostic Procedures
6 Diagnostic Cerebral Angiography
7 Diagnostic Spinal Angiography
8 Diagnostic Cerebral Venography
9 Balloon Test Occlusion
10 Inferior Petrous Sinus Sampling
Part III Extracranial Vessel Angioplasty/Stenting
11 Carotid Artery Stenting with Distal Protection
12 Carotid Artery Stenting with Proximal Protection (Flow Arrest)
13 Carotid Artery Stenting under Flow Reversal
14 Angioplasty for In-Stent Restenosis or Recurrent Stenosis
15 Vertebral Artery Stenting
16 Venus Sinus Stenting
Part IV Acute Stroke Procedures
17 Anterior Circulation Mechanical Thrombectomy (ADAPT)
18 Anterior Circulation Mechanical Thrombectomy with Stent Retriever
19 Posterior Circulation Mechanical Thrombectomy
20 Mechanical Thrombectomy with Intracranial Stenting/Angioplasty
21 Anterior Circulation Mechanical Thrombectomy with Extracranial Stenting/Angioplasty
22 Intracranial Atherosclerotic Disease — Intracranial Angioplasty
Part V Intracranial Aneurysms
23 Primary Aneurysm Coiling
24 Balloon-Assisted Coiling
25 Stent-Assisted Coiling
26 Flow Diversion Treatment of Intracranial Aneurysms
27 Intrasaccular Flow Diverter for Intracranial Aneurysms (WEB)
28 Novel Aneurysm Neck Reconstruction Devices
29 Aneurysm Embolization with Liquid Embolic Agents
30 Endovascular Vasospasm Treatment
Part VI Brain Arteriovenous Malformations and Fistulas
31 Arteriovenous Malformation Embolization with Onyx
32 Arteriovenous Embolization with N-butyl-2-cyanoacrylate
33 Endovascular Embolization of Dural Arteriovenous Fistulas
34 Spinal Arteriovenous Fistula and Malformation Embolization
35 Carotid-Cavernous Fistula Embolization
Part VII Head and Neck Embolization
36 Endovascular Treatment of Epistaxis
37 Central Nervous System Tumors
38 Embolization of Carotid Body Tumors
39 Carotid Blowout Syndrome and Vessel Sacrifice or Reconstruction
Part VIII Endovascular Complications and Management
40 Complications of Neuroendovascular Interventions

Leseproben

1 Femoral Artery Access and Closure

General Description

The most common vascular access approach used for diagnostic cerebral angiography and neuroendovascular interventions is the common femoral artery (CFA). Understanding the anatomy of the femoral artery and related anatomic structures is fundamental to any neurointerventionist to minimize complications during vascular access.

Indications

Femoral artery access is indicated for any diagnostic cerebral angiogram. It is also indicated for most neuroendovascular procedures that require a 7 French (F) or larger sheath for access.

Neuroendovascular Anatomy

The CFA is a continuation of the external iliac artery. The transition from the CFA to the external iliac artery is marked by the inguinal ligament that extends from the bony anterior superior iliac spine to the pubic tubercle. The CFA extends from the inguinal ligament and crosses at the medial third of the femoral head. At the junction of the femoral neck and lesser trochanter, it bifurcates into the superficial femoral artery (SFA) and profunda femoral artery (PFA). Small branches from the external iliac artery, such as the circumflex iliac and deep epigastric, should be identified to avoid placing the access sheath within them and causing vessel rupture and retroperitoneal hematoma.

Specific Technique and Key Steps

It is important to obtain the patient’s history of previous femoral artery access, femoral bypass, stent placement, or surgery at the inguinal region. A complete examination of the groin area with documentation of the femoral, popliteal, and pedal pulses is essential. To maximize the efficiency of neuroendovascular procedures, we routinely obtain percutaneous access through the right femoral artery (Fig. 1.1–1.3 and Video 1.1–1.3), unless a contraindication exists (i.e., scarring from a previous surgery, absence of a femoral pulse, multiple previous punctures/closure device, or pseudoaneurysm formation).

1. After the groin is prepared and draped in sterile fashion, the site of puncture is identified using bony landmarks and confirmed radiographically with an X-ray (Fig. 1.2, 1.3 and Video 1.2, 1.3). The anteri- or superior iliac spine and the pubic symphysis are connected by the inguinal ligament, which marks the superior border of the CFA. This can be palpated in most individuals.

2. The CFA runs medial to the center of the femoral head. This site is found under X-ray using a hemostat for localization and marked. The lower third of the femoral head is the ideal site for vessel puncture.

3. The CFA pulse is elicited, and local anesthesia is infiltrated in the skin and subcutaneous tissue. A single wall puncture of the CFA is performed with a microneedle (21-gauge micropuncture kit) at a 45° angle with the bevel facing up. A single anterior wall puncture technique is used.

4. Once pulsatile bright red blood is encountered, a microwire (0.010-inch diameter Cope Mandril, Cook Medical) is advanced through the microneedle. If resistance is noted, the process is halted, and the microwire trajectory is confirmed with an X-ray. After the trajectory is confirmed, the wire is advanced up and to the left toward the iliac artery and abdominal aorta, avoiding the small lateral side branches. The microneedle is removed and an intermediate dilator (4–5F microsheath) is inserted. The introducer is removed and a 30-cm J-wire is inserted. The intermediate dilator/microsheath is exchanged for a sheath (4–6F). For diagnostic cerebral angiography, a 5F sheath is used for adult cases, and a 4F sheath is used for pediatric cases. Longer femoral sheaths (>25 cm) are considered for patients who are obese or those with very tortuous anatomy (Fig. 1.1, Video 1.1).

5. If a larger diameter femoral sheath is required (7–9F), an intermediate dilator and a longer, stiffer wire should be used (Fig. 1.2 and Video 1.2).

6. After arterial access is established, a femoral artery angiogram (run) is performed before proceeding with the case. We assess for femoral artery patency, stenosis, and dissection, as well as possible extravasation. The groin run is needed to determine whether the arteriotomy can be closed percutaneously with a closure device (e.g., AngioSeal, St. Jude Medical; Perclose, Abbott Vascular; Mynx, Cardinal Health; or Catalyst, Cardiva Medical) (Fig. 1.1–1.6 and Video 1.1–1.6).

Device Selection

1. 4–6F femoral sheath requires the following:

a. Micropuncture kit (microneedle, microwire, microsheath, intermediate sheath, J-wire).

b. 4–6F femoral sheath.

2. 7–9F femoral sheath requires the following:

a. Micropuncture kit (microneedle, microwire, microsheath, intermediate sheath, J-wire).

b. Intermediate dilator (7F).

c. Longer, stiffer wire (i.e., short Amplatz wire, Stiff Glidewire).

Closure Device Selection

1. The AngioSeal device utilizes a collagen sponge that is sandwiched between the inner and outer vessel wall (Fig. 1.4 and Video 1.4). We typically use this device for larger arteriotomies (i.e., 8–9F) and in patients with hemostasis-related issues.

2. The Mynx percutaneous closure device is used for smaller (i.e., 5–6F) arteriotomies typically after diagnostic procedures (Fig. 1.5, 1.6 and Video 1.5, 1.6). The device utilizes an extravascular sealant, and some manual pressure is usually required after placement. In very thin patients, the sealant can extrude to the skin and must be wiped away and more manual pressure applied. The Catalyst device is also utilized for smaller arteriotomies; it requires removal of the device 10 minutes after placement and the application of manual pressure for 20 minutes thereafter.

3. The Perclose device is designed to deliver a prolene stitch at the arteriotomy site. This device is commonly used for 6F openings. The patient is typically given one dose of antibiotics as the stitch is nonabsorbable.

Pearls

• Prepare and drape both groins in patients with weak or nonpalpable femoral pulses or patients with possible difficult access (i.e., obese or peripheral vascular disease) (Fig. 1.2 and Video 1.2). With the use of ultrasound imaging, identify the femoral artery; use an echogenic insulated ultrasound needle for this purpose.

• If resistance is encountered while advancing the microwire or needle wire, stop! Inadvertent advancement within a dissection flap or small caliber vessel is likely when microwire resistance is encountered. Advance the wire under fluoroscopy. Use a nitinol wire; these wires are longer and firmer.

• For pediatric cases, use ultrasound imaging for identification of the femoral artery (Fig. 1.3 and Video 1.3). In these cases, it is not uncommon to puncture the posterior wall inadvertently because of the small artery size. Some interventionists prefer not to use a sheath, and to use the diagnostic catheter directly.

• For obese patients, use long sheaths. Short sheaths can become kinked or may pull out inadvertently.

• Avoid puncturing femoral artery stents. Obtain access above or below the stent or the contralateral femoral artery. Puncture of vascular grafts is acceptable, but special care should be taken with sterile technique and closure. If access was gained through a vascular graft, closure often requires an extra amount of manual compression. We do not recommend the use of any closure device for these cases.

• Pulsatile masses over previous puncture sites should be evaluated with computed tomography angiography of the pelvis or abdomen to determine whether a pseudoaneurysm is present. Another possibility for the evaluation of these masses involves puncturing the contralateral groin and performing a formal femoral angiogram on the suspicious side. Treatment options for pseudoaneurysms include ultrasonic compression, ultrasonic compression with thrombin injection, stenting, and, last, vessel reconstruction.

• Postoperative back pain should be taken seriously as this can be a sign of retroperitoneal hematoma, often from a high-level puncture in which it was difficult to achieve hemostasis. Immediate evaluation with computed tomography imaging is needed.

Case Overview

CASE 1.1 Femoral Artery Access

• A 35-year-old woman presents for evaluation of nonruptured brain arteriovenous malformation. She has no significant past medical history.

• Patient requires a diagnostic cerebral angiogram for further evaluation.

Fig 1.1a Two-hand technique for right femoral artery pulse identification.

Fig 1.1b Right femoral artery...