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Education And Debate

Recent Advances: Interventional neuroradiology

BMJ 1995; 311 doi: (Published 23 September 1995) Cite this as: BMJ 1995;311:789
  1. Wendy Taylor, consultant neuroradiologista,
  2. George Rodesch, consultant neuroradiologistb
  1. a Lysholm Department of Radiology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG
  2. b Service de Radiologie, Hopital de Bicetre, Universitaire de Paris XI, 94275 Pari
  1. Correspondence to: Dr Taylor.

    Interventional neuroradiology aims to cure, ameliorate, or stabilise symptoms due to vascular lesions in the brain or spinal cord and their surrounding tissues. The range of lesions amenable to treatment is wide, but the techniques that are applied are comparatively few. The principal approaches include obliterating abnormal vessels by occlusion with various substances, increasing flow in abnormally narrow vessels, and dissolving blockages produced by fresh thrombus with clot dissolving agents; vascular stents are being assessed for their efficacy in treating carotid stenosis and occluding aneurysms. All are based on an understanding of the natural history of the lesions and the balance of the risk and benefits of treatment in each case.

    Interventional neuroradiology as a developed specialty is 20 years old and was first concerned with extracranial embolisation of vascular lesions and tumours of the head and neck. One of its main contributions is not technical but in the clinicopathological understanding of intracerebral arteriovenous malformations.

    Technical advances

    The principal advances have been in the design of catheters and guide wires. Very small diameter catheters with distal tips of variable stiffness are available. There are flow dependent catheters and catheters that run over guide wires to the correct location. Some guide wires can be coated with a hydrophilic substance to ease their passage through the small cerebral vessels. These systems are usually delivered through a parent catheter, which is constantly perfused with heparinised saline. Technical advances in the catheters have meant that interventional neuroradiologists can treat lesions whose nature and natural history is not completely known. This can result in assessment of technical results without a clear view of the overall outcome for the patient.

    Interventional neuroradiology in children

    Advances in interventional radiology in children have been technical and clinicopathological. The design of catheters has permitted superselective catheterisation directly from the groin. This saves children the extra …

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