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An Overview of the Endovascular Treatment of Intracranial Aneurysms

  • Phil White
  • Johann du Plessis
  • Dipayan Mitra
Chapter

Abstract

Endovascular treatment has become the mainstay of treatment for most ruptured and many unruptured cerebral aneurysms. This chapter first discusses key evidence for this development and presents the equipment and procedures for standard unassisted coiling of cerebral aneurysms. Major complications and management/preventive measures are reviewed together with adjunctive issues such as anaesthesia, anticoagulation and post-procedural care. Then, simpler assist techniques for aneurysm coiling (balloon remodelling and the double microcatheter approach) are described. The second section of the chapter covers reconstructive approaches to the treatment of complex aneurysms. Indications for the use of devices such as stents, flow diverters, other neck bridge devices and intrasaccular flow disruption devices are discussed, and an overview of the evidence for their use provided. Practical technical considerations specific to the use of these devices are presented and complications discussed for each class of device. The final section of the chapter discusses deconstructive and combined endovascular therapy options, along with necessary occlusion testing. The procedural and technical aspects of parent vessel occlusion are presented along with key management tips. A brief overview of combined approaches is given at the end of the chapter. Illustrative figures are provided throughout the text along with key references.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Phil White
    • 1
    • 2
  • Johann du Plessis
    • 2
  • Dipayan Mitra
    • 2
  1. 1.Newcastle University, Institute of NeuroscienceNewcastle upon TyneUK
  2. 2.Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK

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