RESUMEN
Vascular malformations are frequent in the head and neck region, affecting the nervous system. The wide range of therapeutic approaches demand the correct anatomical, morphological, and functional characterization of these lesions supported by imaging. Using a systematic search protocol in PubMed, Google Scholar, Ebsco, Redalyc, and SciELO, the authors extracted clinical studies, review articles, book chapters, and case reports that provided information about vascular cerebral malformations, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 385,614 articles were grouped; using the inclusion and exclusion criteria, three of the authors independently selected 51 articles about five vascular cerebral malformations: venous malformation, brain capillary telangiectasia, brain cavernous angiomas, arteriovenous malformation, and leptomeningeal angiomatosis as part of Sturge-Weber syndrome. We described the next topics-"definition", "etiology", "pathophysiology", and "treatment"-with a focus on the relationship with the imaging approach. We concluded that the correct anatomical, morphological, and functional characterization of cerebral vascular malformations by means of various imaging studies is highly relevant in determining the therapeutic approach, and that new lines of therapeutic approaches continue to depend on the imaging evaluation of these lesions.
RESUMEN
RESUMEN INTRODUCCIÓN: El manejo endovascular de la estenosis de la arteria vertebral en pacientes con infarto cerebral recurrente continúa siendo un tema con múltiples lagunas de conocimiento debido a la poca evidencia científica con la que se cuenta en la actualidad. CASOS CLÍNICOS: Se informan dos casos típicos de estenosis vertebral y recurrencia de infarto cerebral cerebral manejados con dispositivos endovasculares alternativos a los utilizados en la actualidad (stent balón expandible medicado con zotarolimus), con desenlaces clínicos e imagenológicos satisfactorios. Se describe la técnica usada, la condición clínica y se ilustran los resultados angiográficos. CONCLUSIÓN: A la luz de las nuevas generaciones de dispositivos y técnicas neuroendovasculares, consideramos que debe realizarse una evaluación cuidadosa e individual de los pacientes con recurrencia de enfermedad cerebrovascular y estenosis vertebral, a pesar de un manejo médico optimizado. Aún se requieren estudios conrolados que permitan la uniformidad futura en la selección de pacientes y la toma de decisiones.
SUMMARY INTRODUCTION: Endovascular management of vertebral artery stenosis in patients with recurrent cerebral infarction remains a topic with multiple gaps in knowledge because of poor scientific evidence is available today. REPORT OF CASES: Here are reported two typical cases of cerebral infarction recurrence due to vertebral artery stenosis managed with new endovascular devices (balloon-expandable-stent medicated with zotaroli-mus), with satisfactory clinical and neuroimaging outcomes. Herein it is described the technique used and the angiographic findings are illustrated. CONCLUSION: In light of new devices and neurointerventional techniques, we consider that it should be done a careful and individual evaluation of patients with vertebral stenosis and stroke recurrence despite an optimized medical management. It is still required more studies that allow future consistency in the selection of patients and decision making.