1. Interventional Radiology for Emergency Disease of Central Nervous System and Head & Neck
Department of Radiology, Nara Medical University
Takeshi Wada, Hiroyuki Nakagawa, Kimihiko Kichikawa
Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital
Katustoshi Takayama, Kaoru Myochin
Interventional neuroradiology (Neuro IVR) for emergency disease includes acute ischemic stroke, ruptured cerebral aneurysm, sinus thrombosis, dural arterial venous fistula, nasal bleeding, and head and neck trauma. Acute ischemic stroke and ruptured cerebral aneurysm are the most frequent among these diseases. Recently devices for Neuro IVR are remarkably advanced, and the indication and procedures for these diseases are changing.
Especially for the past few years, mechanical thrombectomy devices for acute ischemic stroke are rapidly improving. Interventional radiologists should understand updated indications and techniques of Neuro IVR.
In this article, we review current treatment options for acute ischemic stroke focusing on the latest advances in the field of mechanical thrombectomy and also outline the current strategy of coiling for ruptured cerebral aneurysm based on the recent literature and our experience.
- Interventional neuroradiology
- Acute ischemic stroke
- Ruptured cerebral aneurysm
2. Endovascular Therapy of Emergent Aortic Pathologies
Department of Radiology, Mie University Hospital
Noriyuki Kato, Takashi Hashimoto, Takatoshi Higasigawa, Shuji Chino
Endovascular therapy including stent-graft repair has been established as one of choices for the treatment of various aortic pathologies. It has been also recognized as powerful first-line treatment for aortic emergency because of its relatively low invasiveness. Acute type B aortic dissection complicated with malperfusion is benefitted most from endovascular therapy. On the other hand, type B aortic dissection complicated with aortic rupture seems still challenging due to it complex hemodynamics. Ruptured aortic aneurysms, especially ruptured thoracic aortic aneurysms, are also benefitted from endovascular therapy. Although there remains some limitations and controversies, aorto-bronchial or aorto-enteric fistulae and infectious aortic aneurysms can be treated with endovascular therapy. To improve the results and it should be mandatory to organize medical staffs, outside hospitals, and facilities including backups of devices.
- Endovascular therapy
3. Emergency Interventional Radiology in the Management of Gastrointestinal and Intraperitoneal Hemorrhage
Department of Radiolody, Wakayama Medical University
Akira Ikoma, Motoki Nakai, Hiroki Minamiguchi, Tetsuo Sonomura, Morio Sato
Transcatheter arterial embolization (TAE) is considered a safe and effective primary interventional procedure for gastrointestinal and intraperitoneal hemorrhage. TAE can provide instant and definite hemostasis. However, attention must be paid to avoiding ischemic complications, such as bowel infarction. An increasing number of patients have been treated with TAE using metallic coils and n-butyl-2-cyanoacrylate (NBCA). Several recent studies have reported that NBCA, a permanent liquid embolic material, is a useful alternative to gelatin sponge or microcoils in treating uncontrollable acute arterial hemorrhage. This review describes the indications, pitfalls, embolic materials, and methods of TAE for the management of gastrointestinal and intraperitoneal hemorrhage.
- Gastrointestinal hemorrhage
- Intraperitoneal hemorrhage
4. Endovascular Treatment in the Management of Obstetric and Gynecologic Emergencies
Departments of Radiology, Kitasato University School of Medicine
Reiko Woodhams, Takuro Yamane, Go Ogasawara
Kaoru Fujii, Toshimasa Hara, Keiji Matsunaga, Yusuke Inoue
Department of Cardiovascular Surgery, St. Marianna University School of Medicine
Department of Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital
This article describes the role of endovascular treatment in the management of obstetrical and gynecologic emergencies. Interventional techniques for obstetrical and gynecologic emergencies consist of arterial balloon occlusion and arterial embolization. The operator is supposed to be decisive regarding the choice of interventional technique, and embolic material depending on the patient’s vital signs and cause/site of bleeding. Understanding of the intra-pelvic collateral pathway is essential for obstetrical and gynecologic arterial embolization because of the possibility of bleeding via rich collateral vessels. Postpartum hemorrhage (PPH) is one of the most critical causes of obstetric emergency. Recently, endovascular treatment has been focused on as an effective and safe technique to save PPH patients. Atonic bleeding is the most common cause of primary PPH. Secondary PPH is due to various causes and is less frequent and less critical compared to primary PPH. The main embolic materials chosen for PPH are gelatin sponge and NBCA. Gelatin sponge is commonly chosen first. NBCA can be appropriate for traumatic bleeding, pseudoaneurysm, recanalization after gelatin sponge embolization, and acquired AVM/AVF. Of gynecologic emergencies, tumor bleeding is the predominant indication for endovascular treatment. Various feeding arteries including the mesenteric artery can be the origin of bleeding because of tumor invasion. IPM/CS may be considered for bleeding from the mesenteric artery.
- Arterial balloon occlusion
- Gelatin sponge
5. Interventional Radiology for the Management of Urological Emergencies
Department of Radiology and Center for Endovascular Therapy, Kobe University Hospital
Takuya Okada, Masato Yamaguchi, Akhmadu Muradi, Naoto Katayama
Eisuke Ueshima, Keitaro Sofue, Koji Idoguchi, Koji Sugimoto
Embolization and other endovascular procedures are highly effective and well-tolerated procedure to manage a variety of urological emergencies. The most well-known procedure is embolization of traumatic renal injury. Iatrogenic renal injury is recently increasing due to the popularity of partial nephrectomy. Renal artery occlusion and bleeding from renal tumor are also indications for endovascular procedures. Although rare, uretero-ilio arterial fistula and post-traumatic nonischemic priapism are well treated with this technique. Interventional radiologists should be well acquainted with these urological emergencies.
- Traumatic renal injury
- Iatrogenic renal injury
- Uretero-ilio arterial fistula
6. Interventional Radiology for Trauma
Department of Radiology and Emergency and Disaster Medicine1), Gifu University Hospital
Hiroshi Kondo, Masayuki Kanematsu, Satoshi Goshima,Yukichi Tanahashi
Nobuyuki Kawai, Kota Sakurai, Kunihiro Shirai1), Shinji Ogura1)
Transcatheter arterial embolization has been remarkably advanced and established as a treatment of choice for the management of traumatic bleeding. Expanding the knowledge of treatment strategies for trauma based on accurate diagnosis is crucial for maintaining our skills and improving patient outcome. This review article focuses on the technical aspects of emergent interventional radiology for the treatment of hepatic, splenic and pelvic trauma.
- Taranscatheter arterial embolization
- Blunt abdominal trauma
- Damage control surgery