J Cerebrovasc Endovasc Neurosurg.  2017 Sep;19(3):155-161. 10.7461/jcen.2017.19.3.155.

Endovascular Treatment of Symptomatic Vasospasm after Aneurysmal Subarachnoid Hemorrhage: A Three-year Experience

• Park ES
• Kim DW
• Kang SD

• KMID: 2393497
• DOI: http://doi.org/10.7461/jcen.2017.19.3.155

Abstract

OBJECTIVE
The cause of severe clinical vasospasm after aneurysmal subarachnoid hemorrhage remains unknown, despite extensive research over the past 30 years. However, the intra-arterial administration of vasodilating agents and balloon angioplasty have been successfully used in severe refractory cerebral vasospasm.
MATERIALS AND METHODS
We retrospectively analyzed the data of 233 patients admitted to our institute with aneurysmal subarachnoid hemorrhage (SAH) over the past 3 years.
RESULTS
Of these, 27 (10.6%) developed severe symptomatic vasospasm, requiring endovascular therapy. Vasospasm occurred at an average of 5.3 days after SAH. A total of 46 endovascular procedures were performed in 27 patients. Endovascular therapy was performed once in 18 (66.7%) patients, 2 times in 4 (14.8%) patients, 3 or more times in 5 (18.5%) patients. Intra-arterial vasodilating agents were used in 44 procedures (27 with nimodipine infusion, 17 with nicardipine infusion). Balloon angioplasty was performed in only 2 (7.4%) patients. The Average nimodipine infusion volume was 2.47 mg, and nicardipine was 3.78 mg. Most patients recovered after the initial emergency room visit. Two patients (7.4%) worsened, but there were no deaths.
CONCLUSION
With advances in endovascular techniques, administration of vasodilating agents and balloon angioplasty reduces the morbidity and mortality of vasospasm after aneurysmal SAH.

Keyword

Subarachnoid hemorrhage; Vasospasm; Endovascular therapy; Morbidity; Mortality

MeSH Terms

Aneurysm*
Angioplasty, Balloon
Emergency Service, Hospital
Endovascular Procedures
Humans
Mortality
Nicardipine
Nimodipine
Retrospective Studies
Subarachnoid Hemorrhage*
Vasospasm, Intracranial
Nicardipine
Nimodipine

Figure

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  Fig. 1 Number of patients (A) and endovascular procedures (B).

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  Fig. 2 Aneurysm location in enrolled patients. Acom = anterior communicating artery; Pcom = posterior communicating artery; MCA = middle cerebral artery; ACA = anterior cerebral artery; ICA = internal carotid artery.

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  Fig. 3 Aneurysm location in symptomatic vasospasm. Acom = anterior communicating artery; Pcom = posterior communicating artery; MCA = middle cerebral artery; ACA = anterior cerebral artery; ICA = internal carotid artery.

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