Subject(s)
Balloon Occlusion , Cerebrovascular Disorders/diagnosis , Documentation/standards , Neurosurgery/standards , Balloon Occlusion/adverse effects , Balloon Occlusion/methods , Cerebral Angiography , Cerebrovascular Disorders/surgery , Humans , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Reference Standards , Reproducibility of Results , Skull Base/surgeryABSTRACT
OBJECTIVE: To summarize and classify the evidence for the use of endovascular techniques in the treatment of patients with acute ischemic stroke. METHODS: Recommendations previously published by the American Heart Association (AHA) (Guidelines for the early management of adults with ischemic stroke (Circulation 2007) and Scientific statement indications for the performance of intracranial endovascular neurointerventional procedures (Circulation 2009)) were vetted and used as a foundation for the current process. Building on this foundation, a critical review of the literature was performed to evaluate evidence supporting the endovascular treatment of acute ischemic stroke. The assessment was based on guidelines for evidence based medicine proposed by the Stroke Council of the AHA and the University of Oxford, Centre for Evidence Based Medicine (CEBM). Procedural safety, technical efficacy and impact on patient outcomes were specifically examined.
Subject(s)
Brain Ischemia/therapy , Endovascular Procedures/standards , Stroke/therapy , Thrombolytic Therapy/standards , American Heart Association , Brain Ischemia/drug therapy , Brain Ischemia/surgery , Cerebral Angiography , Combined Modality Therapy , Endovascular Procedures/classification , Endovascular Procedures/instrumentation , Fibrinolytic Agents/therapeutic use , Humans , Practice Guidelines as Topic , Research Report , Societies, Medical/standards , Stroke/drug therapy , Stroke/surgery , Thrombolytic Therapy/classification , United StatesABSTRACT
This is the first in a set of documents intended to standardize techniques, procedures, and practices in the field of endovascular surgical neuroradiology. Standards are meant to define core practices for peer review, comparison, and improvement. Standards and guidelines also form the basic dialogue, reporting, and recommendations for ongoing practices and future development.
Subject(s)
Endovascular Procedures/standards , Neurosurgical Procedures/standards , Practice Guidelines as Topic/standards , Societies, Medical/standards , Endovascular Procedures/trends , Humans , Neurosurgical Procedures/trends , Societies, Medical/trends , Standard of Care/standards , Standard of Care/trendsABSTRACT
BACKGROUND AND PURPOSE: After an initial series of basilar artery stent angioplasty indicated a high technical success rate and minimal morbidity, subsequent reports suggested significant procedural risks. We retrospectively reviewed our experience with basilar artery stent placement to assess complications and clinical outcomes. MATERIALS AND METHODS: Ten consecutive patients with symptomatic intracranial athero-occlusive disease underwent stent placement of the basilar artery at our institution (1999-2003). We collected clinical data by chart review and determined outcomes (modified Rankin Scale [mRS]) by telephone interview. Angiographic data were analyzed by 2 blinded investigators. Clinical and angiographic variables were tested for correlation with outcome and complications using the Pearson correlation test. RESULTS: Of 10 patients (mean follow-up time, 31 months), 4 patients suffered 6 ischemic complications that were immediate in 1, early delayed (<2 weeks) in 4, and late delayed (>2 weeks) in 1. Complications included basilar artery rupture in 1 patient, access site complications in 1 patient, and other non-neurologic complications in 5. Symptomatic restenosis occurred in 1 patient. Outcomes (mRS) were excellent (0-2) in 5 patients, good (3) in 4, and poor (4-6) in 1 patient, who died. Ischemic complications were associated with lesion lumen