The field of neurointervention is in many ways a microcosm of the many trends shaping modern medicine. It is a point of convergence among several traditionally distinct fields: neurology, neurosurgery, and radiology. The "giants" upon whose shoulders the field has been built include Portuguese neurologist Egas Moniz, who first introduced cerebral angiography in 1927; Swedish radiologist Sven-Ivar Seldinger, who enhanced the safety of vascular access and navigation in 1953; and Russian neurosurgeon Fedor Serbinenko, who invented one of the first therapeutic neurointerventional techniques in 1969. The knowledge base and perspective of each field have resulted in a subspecialty that is able to provide highly complex, multidimensional patient care.
Technological advances have served as a constant and powerful driving force within neurointervention. The introduction of detachable coils, liquid embolic materials, intracranial stents, and stroke thrombectomy devices has all occurred within the last two decades. Indeed, the rate of innovation seems to increase with each passing year. This relentless creativity opens windows of therapeutic opportunity but also presents challenges for both neurointerventional practitioners and referring physicians. The pace of innovation has outstripped our ability to rigorously test emerging devices and treatment paradigms. There have been some disappointments when randomized clinical trial data has caught up with a promising new treatment, but this process of creative destruction also has led to great leaps forward in therapeutic safety and efficacy.
As this fast moving field grows, it is important for practitioners of neurointervention to understand their role in the profession as a whole. Where can we be most useful to our medical colleagues and patients? This book serves as a bridge between the neurointerventionalist and the physicians who most frequently look to us for answers to some of the most intractable problems they face. It provides background on the diseases treated through neurointervention along with the indications and alternatives to such treatments.
The book is grouped into four parts: an introduction to the tools and anatomical structures that are integral to the field; disease processes most often encountered by neurologists, cardiologists, and vascular surgeons; those more frequently treated by neurosurgoons; and finally those first seen by several other specialties including ophthalmologists and head and neck surgeons.
Importantly, each chapter includes details of neurointerventional techniques and case discussions that are sufficiently granular to provide a treatment template and guidance to the neurointerventionalist in training and practice. At the same time these descriptions will provide the referring physician with insight into how neurointerventional procedures are performed. Finally, there are several chapters at the end of the text that attempt to look into the crystal ball of neurointervention at what new opportunities await us just over the horizon. St. Louis, MO, USA: Randall C. Edgell

1 The Neurointerventional Toolkit 1

2 Neurovascular Anatomy 11

3 Intensive Care of the Neurointerventional Patient 31

4 Endovascular Treatment of Extracranial Atherosclerotic Disease 51

5 Endovascular Treatment of Intracranial Atherosclerosis 71

6 Clinical and Radiographic Considerations in Acute Stroke Triage 93

7 Intra-arterial Thrombolysis in Acute Ischemic Stroke 109

8 Endovascular Treatment of Cerebral Sinus Thrombosis 125

9 The Role of Wada Testing in Contemporary Epilepsy Surgery 137

10 Unruptured Intracranial Aneurysms 149

11 Ruptured Cerebral Aneurysms 169

12 Arteriovenous Malformations of the Brain 193

13 Intracranial Dural Arteriovenous Fistulae 227

14 Preoperative Tumor Embolization 245

15 Neurointervention in Ophthalmologic Disorders 259

16 Neurointervention and the Otolaryngologist: Head and Neck Surgeon 281

17 Neurointervention and the Endocrinologist: Inferior Petrosal Sinus Sampling 303

18 Neurointervention and Neuroprotection in Stroke 331

19 Just Over the Horizon: Catheter Delivery of Stem Cell Therapy 343

Index 351

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