Handbook Of Cerebrovascular Disease And Neurointerventional Technique

[Curtis Boykins]

Thisfourth edition offers a practical guide to endovascular treatment of cerebrovascular disease and provides a comprehensive reference for the related neurovascular anatomy and the various disorders that affect the vascular system. Chapters cover fundamental principles underlying cerebral and spinal angiography; interventional techniques, devices, and practice guidelines; and commonly encountered cerebrovascular disorders for which interventional and endovascular methods are appropriate

Building on the previous edition, the text is presented similarly in style and scope to emphasize accessibility and ease of reading. All chapters are fully updated to include more recent data, and obsolete products and techniques are replaced with the most current technology. Some key updates include:

Mark Harrigan, MD is an interventional neurosurgeon. He received his medical degree from the University of Washington, did his residency in neurosurgery at the University of Michigan and a fellowship in interventional neuroradiology at the University of Buffalo. He is Director of Interventional Neuroradiology and also the Interventional Neuroradiology Fellowship Director at the University of Alabama, Birmingham. He is an author of more than 130 peer-reviewed publications.

Dr. Mark R. Harrigan grew up in Minnesota and received a B.S. degree in Economics from the University of Minnesota. He received an M.D. degree from the University of Washington in Seattle, Washington, in 1995. During medical school, he was the recipient of the American Federation for Clinical Research E.E. Osgood Award, the Roche Laboratories Award in Basic Science, and the American Medical Association Award for Outstanding Clinical Research.

Dr. Harrigan then did his general surgery internship and neurological surgery residency at the University of Michigan Medical Center under the direction of Dr. Julian Hoff from 1995 to 2002. During his residency, he spent 18 months in the laboratory of Dr. Richard Keep studying cerebral blood flow and the effects of angiogenic factors on cerebral blood flow and ischemia. During this time he also participated in the introduction of clinical cerebral blood flow measurement techniques at the University of Michigan Medical Center, including xenon-CT and CT perfusion. He was the recipient of the Pharmacia Upjohn Research Fellowship in Cerebrovascular Disease, the Michigan Association of Neurological Surgeons Resident Award, and the Fifth International Conference on Xenon CT-CBF Young Investigator Award.

Upon completion of his residency, he did a fellowship in Neuroendovascular Surgery at SUNY Buffalo under the direction of Dr. Nick Hopkins from 2002 to 2004. During this time he received the Sean Mullen Neuroendovascular Fellowship.

Dr. Harrigan's clinical practice includes the operative and endovascular treatment of cerebrovascular disease, as well as general neurosurgery and neurosurgical critical care. His clinical and research interests focus on cerebrovascular disorders. He is the UAB Site Principal Investigator for five multicenter clinical studies. He is active in resident education and was a recipient of a Top Ten Award for Excellence in Resident Education from the Department of Radiology. He is also the co-author, with Dr. John Deveikis, of the Handbook of Cerebrovascular Disease and Neurointerventional Technique.

This book offers a practical guide to endovascular treatment of

cerebrovascular disease and provides a concise reference for the

related neurovascular anatomy and the various disorders that affect the

vascular system. Fully revised and updated, the information is

accessible and easy to read. It discusses fundamental principles

underlying cerebral and spinal angiography; interventional techniques,

devices, and practice guidelines; and commonly encountered

cerebrovascular disorders for which interventional and endovascular

methods are appropriate. New topics and features include: intracerebral

and intraventricular hemorrhage; intracranial tumor embolization;

vasculitis work-up and management; percutaneous carotid artery puncture

technique; and pediatric aspects of neurointerventional techniques and

disease states. Handbook of Cerebrovascular Disease and Neurointerventional Technique,

3rd Edition, is a portable and concise resource for interventional

neuroradiologists, neurologists, neurosurgeons, cardiologists, and

vascular surgeons.

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Cerebrovascular disease refers to a group of conditions that affect blood flow and the blood vessels in the brain. Problems with blood flow may occur from blood vessels narrowing (stenosis), clot formation (thrombosis), artery blockage (embolism), or blood vessel rupture (hemorrhage). Lack of sufficient blood flow (also referred to as ischemia) affects brain tissue and may cause a stroke.

Optimal treatment of these varied cerebrovascular disorders requires experience with a wide spectrum of techniques, including complex cranial microsurgery, and minimally invasive techniques such as endovascular surgery and radiosurgery.

Our team of neurosurgeons and interventional neuroradiologists treat patients who require urgent care for a stroke or bleeding in the brain. We also consult upon patients who are considered stable, but require diagnosis and treatment for a condition like a cerebral aneurysm or a cerebral arteriovenous malformation (AVM).

Experience, outcomes and quality of life are all things that people suffering from a cerebrovascular condition need to consider when looking for treatment options. As one of only a few places in the country that offers comprehensive expertise treating the most complex cerebrovascular disorders with both advanced microsurgery, radiosurgery, and minimally invasive endovascular treatment options, U-M is leading the way in patient safety, patient satisfaction and quality outcomes.

The University of Michigan is the only hospital in Michigan with two neurosurgeons dually-trained in neuroendovascular surgery and open cerebrovascular surgery. Moreover, our dual trained neurosurgeons work shoulder to shoulder with two superb interventional neuroradiologists to create an interdisciplinary team of 4 specialists with advanced training in the minimally invasive endovascular techniques. This truly collaborative team of specialists - who leverage their combined talents for the benefit of their patients by discussing their most challenging cases in a weekly interdisciplinary cerebrovascular conference - makes the University of Michigan one of only a handful of hospitals in the entire country with such a large team of highly trained specialists. Our team approach creates an environment of collegiality and innovation from which our patients can glean the most carefully considered and cutting edge treatments by some of the most experienced and highly trained physicians in the field.

The U-M Cerebrovascular team has performed minimally invasive and complex cranial Cerebrovascular procedures for nearly 15 years, offering patients a high level of experience and access to new options.

Stroke (also known as a cerebrovascular accident (CVA) or brain attack) is a medical condition in which poor blood flow to the brain causes cell death.[5] There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.[5] Both cause parts of the brain to stop functioning properly.[5]

Signs and symptoms of stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, dizziness, or loss of vision to one side.[2][3] Signs and symptoms often appear soon after the stroke has occurred.[3] If symptoms last less than one or two hours, the stroke is a transient ischemic attack (TIA), also called a mini-stroke.[3] Hemorrhagic stroke may also be associated with a severe headache.[3] The symptoms of stroke can be permanent.[5] Long-term complications may include pneumonia and loss of bladder control.[3]

The biggest risk factor for stroke is high blood pressure.[7] Other risk factors include high blood cholesterol, tobacco smoking, obesity, diabetes mellitus, a previous TIA, end-stage kidney disease, and atrial fibrillation.[2][7][8] Ischemic stroke is typically caused by blockage of a blood vessel, though there are also less common causes.[13][14][15] Hemorrhagic stroke is caused by either bleeding directly into the brain or into the space between the brain's membranes.[13][16] Bleeding may occur due to a ruptured brain aneurysm.[13] Diagnosis is typically based on a physical exam and supported by medical imaging such as a CT scan or MRI scan.[9] A CT scan can rule out bleeding, but may not necessarily rule out ischemia, which early on typically does not show up on a CT scan.[10] Other tests such as an electrocardiogram (ECG) and blood tests are done to determine risk factors and rule out other possible causes.[9] Low blood sugar may cause similar symptoms.[9]

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