RESUMO
The field of neurointerventional (NI) surgery has developed in the context of technologic innovation. Many treatments readily provided in 2014 would have been hard to imagine as recently as 10 years ago. The reality of present day NI care is that, while providers, payors, policy makers and patients rely on evidence to guide NI decision-making, the available data are often less robust than participants might desire. In this paper we will explore the fundamentals of evidence-based clinical practice.
Assuntos
Tomada de Decisões , Medicina Baseada em Evidências/métodos , Neuronavegação/métodos , Medicina Baseada em Evidências/tendências , Humanos , Neuronavegação/tendênciasAssuntos
Neurorradiografia/normas , Neurocirurgia/normas , Publicações Periódicas como Assunto/normas , Guias de Prática Clínica como Assunto/normas , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Cimentos Ósseos/uso terapêutico , Políticas Editoriais , HumanosRESUMO
The major efforts to selectively deliver drugs to the brain in the past decade have relied on smart molecular techniques to penetrate the blood-brain barrier, whereas intraarterial drug delivery has drawn relatively little attention. Meanwhile, rapid progress has been made in the field of endovascular surgery. Modern endovascular procedures can permit highly targeted drug delivery by the intracarotid route. Intracarotid drug delivery can be the primary route of drug delivery or it could be used to facilitate the delivery of smart neuropharmaceuticals. There have been few attempts to systematically understand the kinetics of intracarotid drugs. Anecdotal data suggest that intracarotid drug delivery is effective in the treatment of cerebral vasospasm, thromboembolic strokes, and neoplasms. Neuroanesthesiologists are frequently involved in the care of such high-risk patients. Therefore, it is necessary to understand the applications of intracarotid drug delivery and the unusual kinetics of intracarotid drugs.
Assuntos
Encéfalo/efeitos dos fármacos , Artérias Carótidas , Sistemas de Liberação de Medicamentos/métodos , Infusões Intra-Arteriais/métodos , Preparações Farmacêuticas/administração & dosagem , Animais , Barreira Hematoencefálica/efeitos dos fármacos , Encéfalo/irrigação sanguínea , Artérias Carótidas/efeitos dos fármacos , Circulação Cerebrovascular/efeitos dos fármacos , Sistemas de Liberação de Medicamentos/efeitos adversos , Sistemas de Liberação de Medicamentos/tendências , Humanos , Infusões Intra-Arteriais/efeitos adversos , Infusões Intra-Arteriais/tendênciasRESUMO
BACKGROUND AND PURPOSE: Abnormal arterial flow dynamics and intracranial collateral pathways can be seen in patients with congenital internal carotid artery (ICA) aplasia or hypoplasia. Here we seek to evaluate whether ICA aplasia/hypoplasia is associated with an increased prevalence of intracranial saccular aneurysm relative to carotid rete mirabile. METHODS: We combined our experience of three cases with 148 previous publications to form a retrospective series including 132 cases of ICA aplasia, 33 cases of ICA hypoplasia, and 34 cases of carotid rete mirabile. RESULTS: After excluding cases lacking angiograms, ICA aplasia/hypoplasia was more commonly associated with aneurysm (45/158, 27.8%) compared with rete mirabile (2/34, 5.9%). A significantly greater overall aneurysm prevalence was seen among ICA aplasia/hypoplasia patients age 30 years or older (38/101, 36.6%) than in younger individuals (7/48, 14.6%). CONCLUSIONS: Intracranial saccular aneurysm is more strongly associated with ICA aplasia/hypoplasia than rete mirabile. An increased aneurysm prevalence among older individuals with ICA aplasia/hypoplasia suggests an acquired etiology. Magnetic resonance angiography (MRA) is recommended in the initial evaluation of ICA aplasia/hypoplasia to evaluate for intracranial saccular aneurysm, particularly after the third decade of life.
Assuntos
Malformações Arteriovenosas/diagnóstico , Doenças das Artérias Carótidas/diagnóstico , Artéria Carótida Interna/anormalidades , Aneurisma Intracraniano/diagnóstico , Adulto , Angiografia Digital , Doenças das Artérias Carótidas/congênito , Doenças das Artérias Carótidas/terapia , Artéria Carótida Interna/patologia , Feminino , Humanos , Lactente , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler DuplaRESUMO
The management of interventional neurologic patients in the intensive care unit is based on their underlying disease for the most part. Patients with ischemic stroke are largely managed like patients with ischemic stroke who have not undergone interventional procedures, and the same is true for those with an aneurysmal subarachnoid hemorrhage or intracerebral hemorrhage secondary to an arteriovenous malformation, for example.Having said this, there are some special considerations that require special mention when it comes to managing patients after catheter-based procedures.