New Indications for Minimally Invasive Procedures to Treat Diseased Brain Vessels

The American Heart Association (AHA; Dallas, TX, USA) and the American Stroke Association (ASA; Dallas, TX, USA) have published a joint statement providing recommendations for minimally invasive procedures to treat brain blood vessel diseases based on best available evidence.

The new statement addresses the use of stenting, coil embolization, in-artery delivery of clot busting drugs, and mechanical clot-removing devices for the treatment of brain aneurysms, narrowed brain arteries, acute ischemic stroke, and arteriovenous malformations.

A summary of the recommendations includes: (1) Ruptured aneurysms: Endovascular coil occlusion of the aneurysm is appropriate if the aneurysm is deemed treatable by either endovascular coiling or surgical clipping. (2) Unruptured aneurysms: The investigators deem it "reasonable" to consider endovascular occlusion for unruptured aneurysms if the aneurysm is thought to require intervention over conservative management and is amenable to endovascular treatment according to an endovascular specialist. (3) Intracranial stenosis: For symptomatic atherosclerotic stenosis greater than 70% and failing medical therapy, endovascular revascularization with angioplasty or stenting might be reasonable. (4) Acute ischemic stroke: For patients with a major stroke syndrome lasting six hours or less, and who are either ineligible for or who have failed intravenous thrombolysis, it is reasonable to consider intra-arterial thrombolysis in selected patients. For patients with a major stroke syndrome lasting eight or more hours, it may be reasonable to use mechanical disruption to restore blood flow in selected patients. (5) Cerebral arteriovenous malformation (AVM): For patients with hemorrhage referable to an AVM, endovascular treatment in combination with other therapies, such as surgery or radiosurgery, should be considered as a preoperative adjunct or palliative treatment to prevent recurrent hemorrhage. For those with neurologic symptoms or hemorrhage referable to a dural arteriovenous fistula, endovascular treatment alone might be curative or might be used in combination with other therapies, such as surgery or radiosurgery, as palliative treatment to prevent stroke or hemorrhage.

The new statement, titled "Indications for the performance of intracranial endovascular neurointerventional procedures," was published online on April 6, 2009, in Circulation, the journal of the American Heart Association.

Related Links:
American Heart Association
American Stroke Association