Stroke and other neurovascular diseases are leading causes of death and disability worldwide. Endovascular neurosurgery provides several minimally invasive techniques to treat vascular diseases of the central nervous system with faster recovery and less pain and blood loss than with open neurosurgical techniques. Endovascular neurosurgery may be used to treat many different neurologic disorders, including aneurysms (bubble- or blister-like deformations of the arterial wall), acute ischemic stroke, arteriovenous malformations (congenital abnormalities in which arteries drain directly into veins without an intervening capillary bed), tumors, arterial stenosis (narrowing of the artery), and others. Under fluoroscopic guidance, a catheter is introduced into an artery (typically at the groin) and advanced until it reaches its target site within the brain or spinal cord. Several fluoroscopic techniques are used in endovascular neurosurgical procedures, including digital subtraction angiography and angiographic roadmapping. Last fluoroscopy hold makes it possible to retain the last live image on the monitor to allow the interventional radiologist to plan next moves while avoiding additional radiation exposure. Patient preparation includes a review of the patient’s medical record, administration of premedications (eg, antiplatelet agents), and selection of conscious sedation or general anesthesia. Endovascular neurosurgical procedures are associated with relatively high levels of patient radiation exposure compared with other medical imaging techniques, and careful attention to technique is important to reduce the risk of skin injuries and other adverse events.
After reading this article, the participant should be able to:
- Describe the common disorders of the central nervous system that are treated using fluoroscopically guided endovascular procedures.
- Discuss the role of fluoroscopy and other imaging methods in treatment planning and implementation of endovascular neurosurgical procedures.
- Assess and minimize the risks of fluoroscopy-associated radiation injury.
Categories: Fluoroscopy, Radiation Safety/Protection