Purpose of review
The review highlights recent data regarding the safety and efficacy of endovascular treatment of cerebrovascular disease and concerns in anesthesia management.
Ongoing trials, including the Barrow Ruptured Aneurysm Trial and the International Subarachnoid Aneurysm Trial II, are aimed at improving understanding of the applicability of the International Subarachnoid Aneurysm Trial data and the roles of surgical clipping and endovascular treatment in the broad general patient population of ruptured aneurysms. Two recent studies in unruptured brain arteriovenous malformation management – ARUBA (a multicenter, randomized clinical trial) and the Scottish population-based cohort study – concluded that conservative medical management is superior to interventional therapy (including endovascular embolization) in preventing death or stroke. Three randomized clinical trials failed to prove the superiority of endovascular therapy to standard care for acute ischemic stroke, but pointed out to the need and direction of future trials. Studies of anesthesia for acute ischemic stroke suggested that inadequate brain perfusion may contribute to poorer outcome.
Recent data further support the role of endovascular coiling for ruptured aneurysm in broader patient populations. Further studies are needed to investigate the proper management of unruptured arteriovenous malformations, and the key factors in endovascular therapy and anesthesia management associated with stroke outcome.