Surgery, angioplasty, and interventional neuroradiology.

This article discusses recent advances in the treatment of three cerebrovascular conditions, namely carotid stenosis, cerebral aneurysm, and arteriovenous malformation. In all three the aim of treatment is to prevent stroke, and in all three, recent advances in interventional neuroradiology are supplementing traditional surgical techniques. The benefits of endarterectomy for severe symptomatic carotid stenosis have been clearly demonstrated by recent trials, and early case series suggest that percutaneous transluminal angioplasty may provide an alternative treatment. Recent advances in the management of cerebral aneurysm include new treatments for cerebral vasospasm and the use of endovascular occlusion to treat inoperable aneurysms. Endovascular embolization for arteriovenous malformations also looks promising, but more randomized trials are required to establish the benefit of these interventional procedures.