Making repairs with endovascular surgical neuroradiology
Wendi Rank MSN, RN, CNRN, CRNP

December 2012 
Volume 42  Number 12
Pages 41 - 45
  PDF Version Available!

DISEASE OF THE CEREBRAL ARTERIES has been treated with open surgery for decades. Now, treatment with endovascular surgical neuroradiology (ESN) is proving to be a valid alternative to craniotomy and some other less invasive options. This article discusses indications and contraindications for ESN and nursing care for patients pre- and postprocedure.Cerebral aneurysms, brain arteriovenous malformation (AVM), and carotid artery stenosis are cerebrovascular disorders that are amenable to ESN, which is performed angiographically. These procedures require gaining arterial access, usually through the femoral artery. Physicians with special training, usually neurosurgeons or neurointerventionalists, perform these procedures by passing a catheter through the artery to the diseased area. These procedures can be performed with procedural sedation or general anesthesia.1-3To be a candidate for ESN, patients need to meet certain criteria. These criteria are better understood when discussed in relation to the disease processes treatable by ESN. Let's take a closer look at the disorders mentioned earlier and explore when ESN is an option.Cerebral aneurysms are weakened areas of the arterial wall. (See Typical sites of cerebral aneurysm.) Intact aneurysms, which rarely cause noticeable signs and symptoms, often go undetected.4 However, cerebral aneurysms that rupture cause subarachnoid hemorrhage (SAH), a stroke with high morbidity and mortality. Over 50% of patients with SAH die in the first month.4,5Definitive treatment of a cerebral aneurysm requires occluding it from the healthy parent artery. Open surgery to place a clip on the aneurysm has been the standard treatment for decades. In this procedure, the surgeon accesses the aneurysm by craniotomy and places one or more surgical clips at the base of the aneurysm.4Surgical clipping of aneurysms has several advantages: The reliability of clipping is well established, clipped aneurysms rarely recur or require additional treatment,

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