Neuroendovascular Treatments/Procedures

Abstract

Stroke is the second most common cause of death in women and African Americans, the fourth leading cause of death in Caucasians, and the fifth leading cause of death in men in the United States (). In addition, stroke costs the nation greater than $57 billion dollars annually through its direct and indirect costs. For example, in the year 2009 alone, the estimated expenditure on the cost of stroke for hospitalization, rehabilitation, and institutionalization was $68.9 billion. Fortunately, there are many treatment strategies available to individuals who had a stroke if they meet certain clinical and time criteria as well as being geographically located in a region where these treatments are available, such as nationally certified stroke centers. Specifically, intravenous and intra-arterial recombinant tissue plasminogen activator (rtPA) and mechanical thrombolysis are used for acute ischemic stroke, whereas treatments for acute hemorrhagic stroke resulting from subarachnoid hemorrhage secondary to ruptured cerebral aneurysm include both endovascular coiling as well as surgical clipping. However, patient outcomes from some of these treatments are controversial. First, it appears that, although revascularization post mechanical thrombectomy has high success rates, patient clinical and neurological outcomes as evidenced by low modified Rankin Scale scores are not as favorable when compared with intravenous or intra-arterial thombolysis. However, endovascular coiling for ruptured cerebral aneurysms resulting in subarachnoid hemorrhage appears to be superior to aneurysm clipping in both clinical and neurological outcomes. Future studies need to focus on making subject pools more homogeneous as well as using standardized outcome measures to facilitate external validation of their results.

Perioperative Ischemic Stroke in Unruptured Intracranial Aneurysm Surgical or Endovascular Therapy

“…By contrast, the finding that surgical clipping had worse inhospital outcomes than endovascular coiling with significant interaction by ischemic stroke diagnosis is consistent with existing studies. Comparative studies suggest that clinical outcomes are generally better among patients treated with endovascular coiling versus surgical clipping [1,23]. For instance, a greater likelihood of experiencing ischemic and hemorrhagic complications among patients treated with clipping compared to those treated with coiling was previously reported in a large retrospective study involving 4,899 unruptured IA patients (1388 clipping, 3551 coiling) selected from 120 hospitals using the Premier Perspective database [24].…”

“…Stroke is a leading cause of disability resulting from aphasia, hemiparesis, depression, 1 2 2 3 rehabilitation, long-term care, and dependence on individuals and assisted devices [1][2], with considerable healthcare expenditures linked to this chronic condition [1,3]. While ischemic stroke represents 80%-85% of all strokes, intracerebral hemorrhage and subarachnoid hemorrhage (SAH) are two distinctive forms of hemorrhagic stroke, representing 15%-20% of strokes [3][4].…”