- Prof. Elisa F. M. Ciceri, MD
- Department of Neuroradiology, Fondazione IRCCS Neurological Institute C. Besta, Milan, Italy.
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Special Issue Introduction
The approach to neuroimaging of cerebrovascular disease was revolutionized in the early 1900s thanks to the pioneering work of Egas Moniz, who performed the first cerebral angiography via direct puncture of the carotid artery. Interventional neuroradiology was developed more recently, in the 1970s, mainly to support neurosurgery. It initially focused in the treatment of very extensive and deep vascular cerebral/spinal lesions that were deemed inoperable. In the 1980s, as coaxial microcatheters capable of navigating into the intracranial circulation became available, the so-called “flow-controlled” embolizations were dismissed. The detachable balloon technique developed by Serbinenko in Russia and later diffused by Debrun, has made it possible to perform local and accurate treatment of AV fistulas and aneurysms. However, the modern era of Neurointervention began in the following decade, with Guglielmi's controlled detachment platinum coils (GDC) and the progress of biplanar angiography equipment with DSA digital flat-panel technology, allowing 3D and pseudoTC scans.
A lower invasiveness compared to the surgical approach has since contributed to the progressive spread of endovascular treatment techniques. Thanks to improved CT and MRI neuroimaging, the availability of increasingly more performing materials, like catheters, wires and devices, the use of vasoactive and antiplatelet drugs, a better knowledge of the pathophysiology of cerebrovascular diseases and a more specific training of interventional neuroradiologist, huge progress has been made in this discipline in the last decades, to the point that it is now a direct competitor of Neurosurgery in the cerebrovascular field. The most recent challenge in Interventional Neuroradiology is undoubtedly the acute ischemic stroke, with the capability of revascularizing very distal intracranial occluded vessels and restoring the normal hemodynamic in the affected brain by mechanical thrombectomy via aspiration and / or stent-retriever techniques.
Training, equipment and devices are certainly crucial to obtaining the best results in the most complicated scenario, but only a multidisciplinary team of Neuroradiologists, Neurologists and Neurosurgeons will guarantee tailor-made treatments to the patient and his pathology, making the most updated skills, equipment and technologies available, and therefore the best treatment alternatives. The purpose of this special issue is to provide an overview of the most advanced techniques in interventional neuroradiology applied to the most frequent cerebrovascular diseases of both hemorrhagic and ischemic origin, as well as to discuss recent developments and possible alternatives, with an eye to future applications.
KeywordsCerebrovascular disease, stroke, interventional neuroradiology, intracranial hemorrhage
Submission Deadline15 Jan 2021