Guidelines of intracranial neurointerventional procedures

The following are some of the main recommendations in the above document.


  • Ruptured aneurysms —Endovascular coil occlusion of the aneurysm is appropriate if the aneurysm is deemed treatable by either endovascular coiling or surgical clipping (class I, level of evidence B).
  • Unruptured aneurysms —The authors deem it “reasonable” to consider endovascular occlusion for unruptured aneurysms if the aneurysm is thought to require intervention over conservative management and is amenable to endovascular treatment according to an endovascular specialist (class IIa, level of evidence B).
  • Intracranial stenosis—For symptomatic atherosclerotic stenosis greater than 70% and failing medical therapy, endovascular revascularization with angioplasty or stenting might be reasonable (class IIb, level of evidence B).
  • Acute ischemic stroke —For patients with a major stroke syndrome lasting six hours or less who are either ineligible for or who have failed intravenous thrombolysis, it is “reasonable to consider intra-arterial thrombolysis in selected patients” (class I, level of evidence B). For patients with a major stroke syndrome lasting eight or more hours, it “may be reasonable” to use mechanical disruption to restore blood flow in selected patients (class IIb, level of evidence B).
  • Cerebral arteriovenous malformation (AVM)—For patients with hemorrhage referable to a pial AVM, endovascular treatment in combination with other therapies, such as surgery or radiosurgery, should be considered as a preoperative adjunct or palliative treatment to prevent recurrent hemorrhage (class IIb, level of evidence C). For those with neurologic symptoms or hemorrhage referable to a dural arteriovenous fistula, endovascular treatment alone might be curative or might be used in combination with other therapies, such as surgery or radiosurgery, as palliative treatment to prevent stroke or hemorrhage (class IIb, level of evidence C).