A case-based guide to the interventional management of stroke from leading international experts!
Stroke is the most prevalent cerebrovascular emergency, impacting an estimated 15 million people worldwide every year. Endovascular treatment (EVT) of ischemic stroke has expanded at an unforeseen pace, with EVT the most common neurointerventional procedure performed at most large centers. Endovascular Management of Ischemic Stroke: A Case-Based Approach by renowned stroke pioneer Vitor Mendes Pereira and distinguished co-editors features contributions from a "who's who" of global experts. This practical resource provides straightforward guidance for clinicians who need to learn and master state-of-the-art endovascular interventions reflecting the new, evidenced-based treatment paradigm for acute stroke.
This carefully crafted reference takes readers on a journey from the early building blocks that led to modern stroke interventions to meticulous step-by-step descriptions of the latest approaches. Fifty high-yield cases mirror real-life scenarios trainees and professionals are likely to encounter in clinical practice. Seven sections encompass a full spectrum of diverse patient presentations, anatomical variations, advanced techniques, complex pathologies, complications, and stroke mimics.
Key Highlights
Discussion of emerging techniques likely to stand the test of time such as SAVE, ARTS, transradial access, and transcarotid access
Stroke mimics important for differential diagnoses, including hemiplegic migraine, MELAS, RCVS, seizure, and more
An appendix that covers fundamental terms, trials, and tools
This cutting-edge resource is essential reading for trainee and early-career interventionalists, as well as seasoned practitioners in interventional radiology, neuroradiology, endovascular neurosurgery, and interventional neurology.
Table of Contents
Section I: Evolution of Endovascular Management
Case 1: Intra-Arterial Tissue Plasminogen Activator: The First Steps
Case 2: Transcatheter MERCI Clot Retrieval: The Early Generation
Case 3: Penumbra Clot Aspiration Technique: The Dark Days
Case 4: Trevo Stent-Retriever Thrombectomy: Light on the Horizon
Case 5: Solitaire Stent-Retriever Thrombectomy: Building the Evidence
Section II: Case Selection
Case 6: Timing in Stroke and the Tissue Clock
Case 7: Role of Leptomeningeal Collaterals
Case 8: Importance of Clot Burden and Clot Location
Case 9: ASPECTS: When Not to Treat
Case 10: Microbleeds are Not a Contraindication to Thrombolysis in Acute Stroke
Case 11: Stroke Etiologies: Hemodynamic, Embolic, and Perforator Stroke
Case 12: Endovascular Therapy in a Patient With a Proximal MCA Occlusion and No Neurological Deficits
Case 13: MRI in Stroke (Core Size, Mismatch, and New Advances)
Section III: Fundaments and Standard Approaches
Case 14: The Classical Setup: Carotid-T with Balloon
Case 15: M1 Anatomy and Role of Perforators in Outcome
Case 16: Basilar Artery Occlusion
Case 17: ADAPT Technique for Acute Ischemic Stroke Thrombectomy
Case 18: General Anesthesia in Thrombectomy
Case 19: Conscious Sedation in Thrombectomy
Case 20: Endovascular Therapy for Patients With an Isolated M2 Occlusion
Section IV: Advanced Techniques
Case 21: Percutaneous Radial Arterial Access for Thrombectomy
Case 22: Percutaneous Transcarotid Endovascular Thrombectomy for Acute Ischemic Stroke
Case 23: Distal Access Catheter Technique Without Balloon Assistance
Section V: Complex Cases
Case 24: Tandem Lesions
Case 25: Pseudoocclusion
Case 26: Underlying Intracranial Stenosis
Case 27: Intracranial Dissection
Case 28: Hyperacute Extracranial Angioplasty and Stenting: When and How
Case 29: Failed Mechanical Thrombectomy: What to Do Next
Case 30: Rescue Permanent Stenting
Case 31: Acute Dissection With Hemodynamic Infarctions
Case 32: The SAVE Technique
Case 33: ARTS: Aspiration-Retriever Technique for Stroke
Section VI: Complications
Case 34: Clot Migration With Emboli to Distal Territories
Case 35: Endothelial Damage
Case 36: Management of Vessel Perforation During Stroke Intervention
Case 37: Arterial Access Complications
Case 38: Intra-Procedural Vasospasm During Thrombectomy
Case 39: Hemorrhagic Transformation After Endovascular Stroke Therapy
Case 40: Endovascular Treatment of Cerebral Venous Thrombosis
Case 41: Endovascular Thrombectomy for Pediatric Acute Ischemic Stroke
Section VII: Stroke Mimics and Rare Causes
Case 42: Hemiplegic Migraine
Case 43: Intra-Arterial Contrast Injection During CT Angiogram
Case 44: Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS)
Case 45: Reversible Cerebral Vasoconstriction Syndrome (RCVS)
Case 46: Acute Ischemic Stroke Secondary to Cardiac Myxoma Embolus
Case 47: Seizure
Case 48: Cerebral Amyloid Angiopathy
Case 49: Contrast Staining Masquerading as Hemorrhage
Case 50: HaNDL
Appendix: Essential Terms, Trials, and Tools
