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- arteriovenous malformation
- practice guideline
Intracranial endovascular cerebrovascular interventions treat cerebrovascular diseases by use of minimally invasive intravascular techniques. This area of expertise has made tremendous strides during the past decade, and the rate of progress has accelerated as the discipline has gained increasing clinical acceptance. An Accreditation Council for Graduate Medical Education–approved training curriculum has been developed and approved since 2000,1 2 and an increasing body of clinical and scientific evidence demonstrates the application, safety, and efficacy of endovascular techniques for the treatment of cerebrovascular diseases. Several nonneurologically based endovascular subspecialties, such as vascular medicine, vascular surgery, and interventional cardiology, perform carotid artery stent placement with neurorescue via alternative Accreditation Council for Graduate Medical Education pathways, as well as a clinical practice pathway.3
Largely because of developments in computer-aided imaging and high-resolution digital subtraction angiography with reconstruction techniques, as well as easier access to the cerebral vasculature through improved microcatheter design, navigation of the cerebral and spinal vasculature is now de rigueur. Technological developments continue to occur rapidly. The purpose of the present document is to review the current information and data for the efficacy and safety of procedures used for intracranial endovascular interventional treatment of cerebrovascular diseases and to provide recommendations for their use based on the best available evidence. Table 1 shows the American College of Cardiology (ACC)/ American Heart Association (AHA) classification of recommendations and levels of evidence. Moreover, the present document characterizes the expected success and complication rates for intracranial endovascular interventional procedures when performed by highly skilled operators. This information should be useful to enable assessment of the appropriateness, safety, and efficacy of neurovascular procedures for individual operators and institutional programs. A summary of the procedures discussed in this document, recommendations, and levels of evidence is provided in table 2.
This article first appeared in Circulation: Philip M Meyers, H Christian Schumacher, Randall T Higashida, Stanley L Barnwell, Mark A Creager, Rishi Gupta, Cameron G McDougall, Dilip K Pandey, David Sacks, Lawrence R Wechsle. Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation April 2009;119:2235–49. Reproduced with permission from Wolters Kluwer Health.
Competing interests None.
Provenance and peer review Not commissioned; not externally peer reviewed.