Neurointerventional Training for Neurosurgeons: Past, Present, and Future

AbstractEndovascular therapy as any other specialty has continuously been developed since 1904, but acceptability among neurosurgeons remains low despite being other subspecialties and techniques, like endoscope and for that matter microscope also, being adopted very rapidly. From injecting particles for vascular lesions to balloons for fistulas and arteriovenous malformations and embolizing agents to detachable coils for aneurysm coiling, it has come a long way. Old generations of neurosurgeons used to perform carotid puncture for diagnosing mass lesions, but once CT/MRI came in to the picture, this procedure was stopped and handed over to radiologists. A debate continues among neurosurgeons about the feasibility of aneurysm coiling since international subarachnoid aneurysm trial (ISAT) and doubts about the long-term efficacy of this novel treatment cost a subspecialty. With the recent addition of endovascular treatment of stroke and long-term efficacy of endovascular treatment of aneurysm, there is a lot of debate among clinicians and nonclinicians about who will be the true heir of this sub specialty.

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Inhibition of Ras/ERK1/2 pathway contributes to the protective effect of Ginsenoside Re against intimal hyperplasia

Food & Function ◽

10.1039/d1fo00015b ◽

2021 ◽

Author(s):

Chenying Gao ◽

Kaina Zhang ◽

Fanfan Liang ◽

Wenzhuo Ma ◽

Xixi Jiang ◽

...

Keyword(s):

Protective Effect ◽

Endovascular Treatment ◽

Carotid Stenosis ◽

Vascular Injury ◽

Intimal Hyperplasia ◽

Neointimal Hyperplasia ◽

Ginsenoside Re ◽

Term Efficacy

Neointimal hyperplasia is the major cause of carotid stenosis after vascular injury, which restricts the long-term efficacy of endovascular treatment and endarterectomy in preventing stenosis. Ginsenoside Re (Re) is a...

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Long-term efficacy of endovascular treatment of isolated iliac artery aneurysms

La radiologia medica ◽

10.1007/s11547-012-0813-1 ◽

2012 ◽

Vol 118 (1) ◽

pp. 62-73 ◽

Cited By ~ 9

Author(s):

R. Fossaceca ◽

G. Guzzardi ◽

M. Di Terlizzi ◽

I. Divenuto ◽

P. Cerini ◽

...

Keyword(s):

Endovascular Treatment ◽

Iliac Artery ◽

Term Efficacy ◽

Isolated Iliac Artery Aneurysms

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Endovascular treatment of carotid-cavernous fistulae: Long-term efficacy and prognostic factors

Journal Français d Ophtalmologie ◽

10.1016/j.jfo.2015.04.021 ◽

2016 ◽

Vol 39 (1) ◽

pp. 74-81 ◽

Cited By ~ 1

Author(s):

S. Stéphan ◽

R. Blanc ◽

M. Zmuda ◽

C. Vignal ◽

M. Barral ◽

...

Keyword(s):

Prognostic Factors ◽

Endovascular Treatment ◽

Term Efficacy

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New Devices Designed to Improve the Long-Term Results of Endovascular Treatment of Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101990401000201 ◽

2004 ◽

Vol 10 (2) ◽

pp. 93-102 ◽

Cited By ~ 1

Author(s):

J. Raymond ◽

P. Leblanc ◽

M. Chagnon ◽

G. Gévry ◽

J.-P. Collet ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Controlled Trial ◽

Long Term Results ◽

Secondary Outcome ◽

Endovascular Coiling ◽

Double Blind Study ◽

Double Blind ◽

Term Efficacy

Endovascular coiling can improve the outcome of patients with ruptured intracranial aneurysms, but angiographic recurrences are frequent compared to surgical clipping. New coils or devices have been introduced to improve long-term results of endovascular treatment but none have been the object of a valid clinical trial. We have proposed a multicentric randomized double-blind study comparing radioactive and standard coil occlusion of aneurysms. The purpose of this article is to review issues that are specific to the design of clinical trials to assess embolic agents that could improve the long-term efficacy of endovascular treatment of intracranial aneurysms. The proposed trial is a randomized, multi-center, prospective, controlled trial comparing the new generation coils to standard platinum coils. Blinding, if at all possible, is preferable to minimize bias, at least for follow-up angiographic studies that should cover a period of 18 months. All patients with an intracranial aneurysm eligible for endovascular treatment would be proposed to participate. The study would enrol approximately 500 patients equally divided between the two groups, recruited within two years, to demonstrate a decrease in the recurrence rate, the primary outcome measure, from 20% to 10%. Secondary outcome measures should assure that complications, initial clinical and angiographic results remain unchanged. Independent data safety and monitoring committees are crucial to the credibility of trials and to ensure scientific rigor and objectivity. The scientific demonstration of an improved long-term efficacy, without significant compromise regarding safety, is mandatory before considering the widespread use of a new embolic device for the endovascular treatment of aneurysms.

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Long-Term Angiographic Recurrences After Selective Endovascular Treatment of Aneurysms With Detachable Coils

Stroke ◽

10.1161/01.str.0000073841.88563.e9 ◽

2003 ◽

Vol 34 (6) ◽

pp. 1398-1403 ◽

Cited By ~ 977

Author(s):

Jean Raymond ◽

François Guilbert ◽

Alain Weill ◽

Stavros A. Georganos ◽

Louis Juravsky ◽

...

Keyword(s):

Endovascular Treatment ◽

Detachable Coils

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Endovascular Treatment of Basilar Tip Aneurysms with Guglielmi Detachable Coils: Predictors of Immediate and Long-term Results with Multivariate Analysis—6-year Experience

Radiology ◽

10.1148/radiol.2263011957 ◽

2003 ◽

Vol 226 (3) ◽

pp. 867-879 ◽

Cited By ~ 73

Author(s):

Jean-Noël Vallée ◽

Armand Aymard ◽

Eric Vicaut ◽

Mauro Reis ◽

Jean-Jacques Merland

Keyword(s):

Multivariate Analysis ◽

Endovascular Treatment ◽

Long Term Results ◽

Guglielmi Detachable Coils ◽

Detachable Coils

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Endovascular Treatment of Unruptured Intracranial Aneurysms With Guglielmi Detachable Coils: Short- and Long-Term Results of a Single-Centre Series

Yearbook of Diagnostic Radiology ◽

10.1016/s0098-1672(08)79047-7 ◽

2008 ◽

Vol 2008 ◽

pp. 274-275

Author(s):

A.G. Osborn

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Long Term Results ◽

Guglielmi Detachable Coils ◽

Single Centre ◽

Unruptured Intracranial Aneurysms ◽

Detachable Coils ◽

Short And Long Term

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Endovascular Treatment of Ruptured Intracranial Aneurysms with Detachable Coils: Long-term Clinical and Serial Angiographic Results

Radiology ◽

10.1148/radiol.2273020656 ◽

2003 ◽

Vol 227 (3) ◽

pp. 720-724 ◽

Cited By ~ 140

Author(s):

Menno Sluzewski ◽

Willem Jan van Rooij ◽

Gabriël J. E. Rinkel ◽

Douwe Wijnalda

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Detachable Coils ◽

Ruptured Intracranial Aneurysms

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Spontaneous Thrombosis of Significant Aneurysm Recanalization in the Long Term Follow-up of Coiled Aneurysms: Observation in Two Cases

Interventional Neuroradiology ◽

10.1177/159101990501100208 ◽

2005 ◽

Vol 11 (2) ◽

pp. 167-171 ◽

Cited By ~ 2

Author(s):

I. Saatchi ◽

U. Kerimoglu ◽

C. Barbaros ◽

T. Haziroln ◽

S. Cekirge

Keyword(s):

Endovascular Treatment ◽

Treatment Strategies ◽

Cerebral Aneurysms ◽

Spontaneous Thrombosis ◽

Long Term Follow Up ◽

Detachable Coils ◽

One Year ◽

Control Angiography

Endovascular treatment of cerebral aneurysms with detachable coils has now been proved to be a superior alternative to open microsurgery in terms of survival free of disability at one year according to the recently published large randomized International Subaracnoid Aneurysm Trial (ISAT). However, aneurysm recanalization secondary to coil compaction is still the main problem of this technique observed in the follow-up period but treatment strategies for these regrowths are not yet well established. We present two interesting cases in which we observed a significant aneurysm recanalization at six month control angiography that was found to be spontaneously thrombosed in the late follow-up angiograms at the second and fifth years consecutively.

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