Destructive strategies in treating cerebrovascular pathology: Review and treatment algorithm

The goal of cerebrovascular pathology treatment is most often to angiographically eradicate a lesion with the lowest probability of morbidity. Destructive strategies using parent vessel occlusion are less commonly considered in the modern era. We review principles of parent vessel occlusion for trea...

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Bibliographic Details
Published in:Revue neurologique 2022-12, Vol.178 (10), p.1031-1040
Main Authors: Zakaria, J., Gonzalez, S.-M., Serrone, J.C.
Format: Article
Language:English
Subjects:
Aneurysm
Cerebral Angiography
Cerebrovascular
Cerebrovascular Disorders - therapy
Embolization, Therapeutic - methods
Humans
Intracranial Aneurysm - therapy
Parent vessel occlusion
Postoperative Complications - therapy
Stroke
Vessel sacrifice
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Summary:The goal of cerebrovascular pathology treatment is most often to angiographically eradicate a lesion with the lowest probability of morbidity. Destructive strategies using parent vessel occlusion are less commonly considered in the modern era. We review principles of parent vessel occlusion for treatment of cerebrovascular pathology and select cases to demonstrate these principles. Many common cerebrovascular conditions have been safely and effectively treated with destructive strategies including intracranial aneurysms, traumatic craniocervical vascular injuries, and oncologic indications such as carotid blowout. Avoiding procedural morbidity in these procedures involves assessment of collaterals distal to a planned parent vessel occlusion, determination of this arterial segment's eloquence, prevention of distal migration of endovascular devices or thrombus, and prevention of stump emboli. An algorithm for case selection and method of destructive technique versus a reconstructive approach can be used. Destructive strategies for treating cerebrovascular pathology are still relevant and can be applied safely in appropriately selected cases.
ISSN:0035-3787
DOI:10.1016/j.neurol.2022.06.005