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(Stroke. 2003;34:357.)
© 2003 American Heart Association, Inc.

Advances in Stroke 2002

Advances in Interventional Neuroradiology

David M. Pelz, MD, FRCPC

From the London Health Sciences Centre, Department of Diagnostic Radiology, London, Ontario.

Correspondence to David M. Pelz, London Health Sciences Centre, Department of Diagnostic Radiology, 339 Windermere Rd, London, ON N6A 5A5 Canada. E-mail pelz@julian.uwo.ca

Key Words: carotid stenting • cerebral aneurysm • embolization • interventional neuroradiology • thrombolysis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The year 2002 in therapeutic neuroradiology has been dominated by the publication of the International Subarachnoid Aneurysm Trial (ISAT), which has already generated considerable debate among those who treat cerebral aneurysms. Although less dramatic, advances have also occurred in the areas of extracranial and intracranial angioplasty/stenting, endovascular stroke therapy, and cerebral arteriovenous malformation (AVM) embolization.

Cerebral Aneurysms

Guaranteed to be controversial, the interim results of ISAT¹ showed a 22.6% relative and a 6% absolute risk reduction of dependency or death for coiling relative to surgery in the treatment of cerebral aneurysms, triggering a premature halt to the trial. The results suggest that in patients with small, ruptured anterior circulation aneurysms who are a good neurologic grade and are candidates for either endovascular coiling or surgery, the incidence of an outcome free of disability at 1 year is higher with coils. Critics have vocally pointed out the large number of anterior circulation aneurysms (97%), the large number of patients who were eligible for the study but were not randomized (7416), the initially limited follow-up, and the small number of participating North American centers, reflecting a known practice bias. The continuing analyses of this data, particularly long-term recanalization rates with coils, promise to be very instructive. Nevertheless, the future of aneurysm surgery may ultimately belong to those who can coil or clip.

There have been many modifications and advances in coil technology to address the problems of wide-necked aneurysms and recanalization. Coils have been used to deliver beta radiation,² bioabsorbable polymers,³ and gene-delivery vectors⁴ . . . [Full Text of this Article]

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