Interventional Radiology - The Stroke Patient
The role of interventional radiologists in the management of stroke patients.
Introduction
A stroke/cerebrovascular accident (CVA) is an acute life-threatening condition where rapid action is crucial to minimize consequences (death or permanent neurological damage) and promote recovery: "Time is Brain". Therefore, swift and adequate emergency care, diagnosis, and treatment are essential.
Since 2015, a new treatment for CVA, mechanical thrombectomy, has been included in the guidelines, where a clot in a cerebral artery is mechanically removed. Typically, this procedure is performed by an interventional radiologist (a subspecialty within the field of radiology). Many hospitals have created care pathways to ensure good and efficient care delivery, establishing clear agreements between the neurology and radiology/interventional radiology specialties.
The importance of advanced imaging (particularly CT angiography and CT perfusion) and an explanation of the intervention procedure (mechanical thrombectomy) will be extensively covered in this module. Additionally, a practical insight into the overall process of multidisciplinary care for CVA patients will be provided.
KEY TOPICS/TERMS:
- Ischemic stroke
- Hemorrhagic stroke
- Brain lobes
- Cerebral vascular territories
- Anterior and posterior circulation
- Circle of Willis
- Segments of internal carotid artery (ICA)
- Segments of middle cerebral artery (MCA)
- National Institutes of Health Stroke Scale (NIHSS)
- Ischemic changes on non-contrast CT brain
- Dense vessel sign / dot sign
- Insular ribbon sign
- Alberta Stroke Program Early CT Score (ASPECTS)
- Large Vessel Occlusion
- CT angiography
- CT perfusion (MTT, CBF, CBV, Tmax)
- Time-density curve
- Core and penumbra
- Carotid artery obstructions
- Carotid artery dissection
- Carotid artery pseudo-occlusion
- Intravenous thrombolysis (IVT)
- Digital Subtraction Angiography (DSA)
- Intra-arterial thrombectomy (IAT) / mechanical thrombectomy
- Stent retriever and aspiration
- Modified Treatment in Cerebral Infarction (mTICI)
- Carotid artery stenting
- Modified Rankin Scale (mRS)
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Text & Illustrations
drs.A. van der Plas, MSK radiologist Maastricht UMC+
For content review, special thanks to:
Prof. dr. W.H. van Zwam, interventional radiologist Maastricht UMC+
Dr. S.W. de Boer, interventional radiologist Maastricht UMC+
Sources:
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S.M Pilgram-Pastor et al.; Stroke thrombectomy complication management. J Neurointerv Surg. (2021)
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26/02/2024
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