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In the recent past endovascular approach for management of stroke and various complex neurovascular lesions has advanced significantly. Today this approach is preferred for the treatment of carotid, vertebral and basilar stenosis, brain aneurysms, cerebral and spinal arteriovenous malformations (AVM), dural cerebral and spinal arteriovenous fistulas (Dural AVF), vascular trauma, etc. Endovascular embolization of vascular tumors of the cranial base and other head and neck regions play an important role in the safe and radical surgical resection of these otherwise difficult to access locations.

Intra-arterial thrombolysis in acute stroke management has offered a new dimension for the treatment of ischemic stroke. Advancements in the techniques of neuro-imaging have contributed significantly to the understanding of ischemia of the brain and in case selection within window period. Carotid and vertebro-basilar stent assisted angioplasty is seen as an alternative to its surgical counterpart, carotid endarterectomy, in the secondary prevention of stroke in high degree carotid and vertebral stenosis.

Intracranial haemorrhage due to aneurysm, AVM, and dural AVF has always been a matter of great surgical concern. Surgical results of the treatment of these lesions located in difficult areas of the circle of Willis and eloquent area of the brain has been discouraging. Endovascular approach in such situation is very rewarding. Today endovascular treatment of ruptured aneurysm by coiling and other techniques is the preferred method over surgical clipping. Results of the randomized, double blind, multi-center ISAT trial published recently has shown superiority of endovascular coiling over surgical clipping.

Endovascular embolization of AVM and dural AVFs is one of the best ways to eliminate these malformations from the circulation immediately to prevent them from re-bleed. Glue (NBCA) embolization offers a permanent obliteration of AVM in majority of the cases.

Preoperative tumor embolization of vascular tumors like meningioma, juvenile angiofibroma, glomus tumors, haemangiomas etc. has been of great help to neurosurgeons. It causes tumor necrosis, and thus changes the consistency of the tumor from hard or firm to soft or less firm. It also reduces blood loss during surgery and offers better operative vision due to less blood in the operative field.

Other applications of Interventional Neuroradiology, also known as Neuro Endovascular Therapy (NET) are treatment of vascular trauma, dealing with life threatening bleeding, treatment of vasospasm in SAH, and intra-arterial chemotherapy.