J Korean Med Assoc.  2008 Oct;51(10):913-924. 10.5124/jkma.2008.51.10.913.

Updated Interventional Neuroradiology in the Neurovascular Diseases

• Kim HS
• Kim HJ
• Suh DC

• KMID: 2065031
• DOI: http://doi.org/10.5124/jkma.2008.51.10.913

Abstract

Rapid and continuous progression in the field of interventional neuroradiology (INR) has allowed many surgically difficult cranial vascular lesions to be treated effectively and less invasively. Development of high-resolution fluoroscopy and digital subtraction angiography also contributed to expansion of the role of the INR. The spectrum of INR application includes intracranial and extracranial stenosis, aneurysms, arteriovenous malformations, hypervascular tumors, and bleeding. Introduction of new devices and materials is so rapid that it is difficult to get outcome evaluation and reimbursement by the insurance which requires a long period of process. Role changes of the physicians and the hospitals seem to be considered for the patients who had required difficult surgery and perioperative surgical management.

Keyword

Intervneitonal neuroradiology; Interventional procedure; Atherosclerosis; Aneurysm; Vascular malformation

MeSH Terms

Aneurysm
Angiography, Digital Subtraction
Arteriovenous Malformations
Atherosclerosis
Constriction, Pathologic
Fluoroscopy
Hemorrhage
Humans
Insurance
International Normalized Ratio
Vascular Malformations

Figure

• 

  Figure 1 A 72-year-old male presented with walking difficulty and sleeping tendency. He had hypertension,and artrial fibrillation. (A) Anterioposterior view of the right vertebral angiogram shows a stenosis of the right vertebralbasilar junction (VBJ) and occlusion of the left VBG. Note the anterior spinal artery (arrow) arising from the right VBJ precluding stenting at the right side. (B) Probing of the occluded left VBJ was possible to open the lumen with complete filling of the posterior circulation as shown in (C). Six month clinical follow-up showed improvement of his symptom and no evidence of stroke recurrence.

• 

  Figure 2 A 59-year-old male with hypertension revealed an incidentally found an anterior communicating aneurysm on MR angiography (A). (B) Note broad neck of the aneurysm. (C) Balloon protection (arrow) of the neck was done during coiling of the aneurysm. (D) A stent was deployed for the small residual neck of the aneurysm (D). (E) 3D angiogram reveals a coiled mass (red mass) and stent marginal markers with red dots (arrows). There was no additional symptom or aneurysm filling (not shown) at 6 month follow-up.

• 

  Figure 3 A 30-year-old female presented with progressive lower leg weakness and voiding disturbance for two months. (A) Sagittal T2-weighted image shows a swollen edematous spinal cord (long arrow) and tortuous abnormal vessels (short arrow). (B) The right L2 lumbar arteriogram showa a large feeder of the posterior spinal artery and nidus and dilated draining vein. (C) selection angiogram shows the nidus.of spinal arteriovenous fistula. (D) angiogram obtained after glue embolization. (E) Two month follow-up MRI shows marked improvement of the swelling and edema of the spinal cord with improvement of her symptom.

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