title: Endovascular treatment of cerebrovascular disease.
abstract: OBJECTIVE
  This review summarizes recent advances in endovascular therapy for cerebrovascular disease.
  
  
  RESULTS
  For ruptured aneurysms, the only large, randomized, controlled trial comparing surgical and endovascular treatment (the International Subarachnoid Aneurysm Trial) resulted in a significant reduction in death or dependency at 1 year, compared with surgery, providing sound evidence that coiling should be the treatment of first choice. Data from the International Study of Unruptured Intracranial Aneurysms demonstrated that treatment of unruptured anterior circulation aneurysms of under 7 mm with no history of subarachnoid hemorrhage is not justified. Embolization of arteriovenous malformations, as sole therapy, is curative only in a small percentage of cases, but can be part of a multimodal approach for reducing arteriovenous malformation size prior to surgery or radiotherapy. Partial treatment of complex arteriovenous malformations may be more dangerous than no treatment. Protection devices can reduce complication rates in carotid artery stenting, but scientific evidence is still lacking. Until the results of comparative trials are available, carotid artery stenting is indicated only in selected patients. Angioplasty and stenting of intracranial arterosclerotic disease is feasible but remains a high-risk procedure, indicated only in highly selected patients. In acute stroke therapy, new thrombolytics and clot-retrieval devices may result in better recanalization rates.
  
  
  CONCLUSIONS
  Advances in endovascular therapy have occurred in all areas of cerebrovascular disease. To obtain maximal patient benefit, endovascular treatment should be performed as an interdisciplinary approach in high-volume centers. Importantly, long-term follow-up review is necessary to clarify the overall role of endovascular treatment in the management of cerebrovascular disease.
authors.affiliation: Department of Neuroradiology, Diagnostic and Interventional Radiology, University of Essen Medical School, Essen, Germany. arnd.doerfler@uni-essen.de
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Becker
authors.forename: Isabel
authors.initials: I
authors.lastname: Wanke
authors.forename: Sophia
authors.initials: S
authors.lastname: Goericke
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
mesh_terms: D001165:Arteriovenous Malformations / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery; D016893:Carotid Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002537:Intracranial Arteriosclerosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods / Q000639:trends*; D020521:Stroke / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods / Q000639:trends*