Catheter intervention for carotid and cerebrovascular diseases

Catheter intervention for carotid and cerebrovascular diseases is rapidly developing treatment modality as another vascular diseases. Recent advancement has been based on stent technology. In the carotid field, self-expanding stents have been widely used, and now embolic protection devices (EPDs) were used in all cases to prevent intraprocedural embolic complication. Current approved EPDs were categorized to distal filter type, Angioguard RX and FilterWire EZ and distal balloon type, Percusurge Guardwire. In 2010, CREST study showed CAS and CEA are both safe and useful as carotid revascularization. Another important intervention is recanalization therapy for acute stroke. Merci, mechanical thrombectomy device, is approved in 2010 and this device indicated for contra- or failed iv rt-PA therapy. Multi MERCI trial showed successful recanalization is most important factor for favorable outcome. Embolization for intracranial aneurysms is also important therapy in neuro-intervention. Detachable coils and adjunctive technique, balloon assist embolization, double catheter technique, and another techniques, have been used in this treatment. Self-expanding stents have been used in recent years. In 2010, Enterprise was approved in Japan and recommended to use for 7 mm or more larger wide neck unruptured aneurysms. Although there is not enough clinical evidence and appropriate devices for intracranial vessels, it seems to be a potentially effective in the future.