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Abstract Stroke is a highly heterogeneous disorder with distinct subtypes, each presenting specific clinical and epidemiological aspects in developed countries, cerebral infarction represents the most common type of stroke and may be further differentiated in subtypes. Ischemic Stroke results from a transient or permanent reduction in cerebral blood flow that is restricted to the territory of a major brain artery. The reduction in flow is, in most cases, caused by the occlusion of a cerebral artery either by an embolus or by local thrombosis. With an incidence of approximately 250–400 in 100 .000 and a mortality rate of around 30 %.A new era of widespread use of endovascular therapy for patients with may ultimately emerge. In particular, direct bypass for patients with symptomatic severe ICA or MCA stenosis appears to be one of available strategies of management. A rediscovery of some of our most difficult surgical techniques, including complex -and advancement in neuroendovascular technology, has enabled us to tackle extremely complex cerebrovascular diseases with improved safety and effectiveness. |