Neurointerventional Radiology
Principals
- aneurysms - dome needs to be protected
- DSA
1/100 complication
1/1000 stroke
Thrombectomy
- TICI score
Embolizations
- liquid embolic agent or embospheres
- liquid agest are onyx, glue, and squid
Onyx (superbond)
- onyx touches blood and solidifies
> black color
> if near skin causes black tattoo
- needs DMSO in catheter before placing onyx (otherwise clot catheter)
> DMSO smell terrible
Glue (NBCA)
- looks like onyx, but do not stain the skin (in facial AVMs)
> solidifies w/ blood & saline, so use D5W (flush D5W)
- mix (glue & oil, ratio 3:1) (higher ratio - low coagulation time)
- radiopaque
Squid
- smaller particle size when compared to onyx
Embospheres
- mix liq & microspheres
- transient embolization
Stents
Extracranial stenting
- extracranial carotid artery stenting (CAS)
> precise (open cell)
> xact (closed cell)
> cristallo (hybrid)
Precise
-non-tapered (equal diameter)
>6 mm x 40 mm
Xact
-tapered (can change size)
>6-8 mm x 40 mm
Intracranial stenting
- intracranial: atlas, onyx stent, cardiology stents, and flow diverting stents
Atlas
-deploy-open, no radioforce
Onyx
- pressure ballon
> pressure seen in the hand
- stent can be messed up w/ size due to atherosclerosis
Cardiology stent
- higher radioforce
- not common in SNC because SNC has small adventia and intima
Flow divert stent
- higher metal (30%) when compared to other stents (17%)
- pipeline, FRED, surpass, silk vista baby
- close aneurysm by itself
Coils
- many brands
- diameter (1st number) and length (2nd number)
- coil the way that they like
Intrasaccular devices
- square or round devices, which opens inside aneurysm
- basilar tip aneurysms
- radiopaque material below tip (can perforate)
Closure devices
- 4 main devices
> Perclose (suture-mediated)
> Minks (extravascular sealant)
> Angioseal (intravascular sealant)
> CELT (mechanical non-suture)
Perclose
- suture
- subcutaneous venous bleeding (no pulsatile)
- collage and plug, with a tiny little bump in the artery, which dissolves with time
- less robust closure (5-6 French in diagnostic procedure)
Angioseal
- deploys a plastic foot plated
- problem is atherosclerotic plaques, wrong anatomic positioning leading to bleeding (not closing)
CELT
- deploy a small disc sitting in the artery inside & outside
- can deploy in other places, causing ischemia
- radiopaque, can be localized
