NEUROINTERVENTION

FOR ACUTE AND CHRONIC STROKE

Fritz S. Usman SpS(K), FINS, FINA

Neurologist & Interventional Neurologist
RS. Pelni Petamburan Jakarta
RS. Mitra Keluarga Bekasi Timur
 Acute & Chronic phase

Cerebral Arteriografi
aka. Cerebral DSA
- Method
- Benefit
- Safety
1.Gold standard for anatomical circumstances,
anastomosis, and collateral brain's vessels
2.Gold standard for [brain] aneurysm, malformation and
fistulas
3.Effective procedure for intra arterial thrombolysis
4.Measuring degree of stenosis resembles the actual
condition
5.Imaging view to display an actual size ( max reduction
10% )
 Rate of complication

Neurology Complication
Non neurology
Author N transient reversible permanent complication

% % % %

1 Guo,Piza,Rubin,Dorsch et al / 2007 203 1.5 0.5 1.5

2 Willinsky,Montanera,terBrugge et al / 2003 2899 0.7 0.2 0.5

3 Kaufmann,Houston et al / 2007 19826 2.09 0.36 0.14 4.5

4 Heisserman,Dean et al / 1995 1000 0.5 0.1 0.5

5 Leffers, Wagner / 2000 483 1.2 0.7 0.4 14.7

6 Dawkins,Evans et al / 2007 2924 0.34 0.45 0 0.41

7 Thiex,Norbasch et al / 2010 1715 0.05 0 0 0.5

8 Burger,Murphy et al / 2006 ( children ) 241 0 0 0 0.05

9 Usman,Sani,Hakim/2012 200 0 0,5 0 0

Tn. S , 59 thn , Vertebro basiler Insuficiency
IA Thrombolysis & Thrombectomy

Time limited
FDA approved
Inclusion and exclusion criteria
Methode
Indication
Contraindication
complication
Thrombolysis
Thrombectomy
 Methode
Indication
Contraindication
complication
Laki laki 35 tahun , 3x serangan stroke dalam 2 tahun terakhir
WEAVE TRIAL
( FINAL RESULT )

With experienced interventionalists, and

proper patient selection following the on-
label usage guidelines, the use of the
Wingspan stent for intracranial
atherosclerotic disease demonstrated a
low periprocedural complication rate and
excellent safety profile.
*

Methode
Indication
Contraindication
complication
You have to point this :

Embolization for vascular malformation not for increase of general

condition.
Embolization for vascular malformation not for discontinue epilepsy drugs

Embolization for vascular malformation only for prevent rebleeding

AVM / AVF should undergo embolization , but not immediately...depends a

lot of factors .......
- bleeding or not
- symptomatic or asymptomatic
Coiling of aneurysm

Methode
Indication
Contraindication
complication
Coiling of Aneurysm
Bilateral Mirror kissing aneurysm, one step
You have to point this :

Coiling for aneurysm not for increase general

condition

Subarachnoid Haemorhage causing by aneurysm

should coil or clipping immediately
 Methode
Indication
Contraindication
complication
Carotid Cavernosus Fistula
 A little bit of us
Start in 2008 --- 1 ( RSUP Jakarta Selatan)
In 2021 --- we’re ……… 55

Medan Semarang Mataram

Riau Surabaya Bekasi
Jakarta Denpasar Tangerang
Banten Banyumas Palembang
Bandung Cibinong Aceh
Bogor Makasar Purwokerto
Solo Papua Lampung
Pontianak Mojokerto Malang
Jogjakarta Manado Bengkulu
Jambi Klaten Palangkaraya
www.jnevi.com
www.neurointervensi.org
www.tentangstroke.com

Most Thank You