Endovascular Treatment of Symptomatic Vasospasm after Aneurysmal Subarachnoid Hemorrhage: A Three-year Experience.
10.7461/jcen.2017.19.3.155
- Author:
Eun Sung PARK
1
;
Dae Won KIM
;
Sung Don KANG
Author Information
1. Department of Neurosurgery, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea. kimdw@wku.ac.kr
- Publication Type:Original Article
- Keywords:
Subarachnoid hemorrhage;
Vasospasm;
Endovascular therapy;
Morbidity;
Mortality
- MeSH:
Aneurysm*;
Angioplasty, Balloon;
Emergency Service, Hospital;
Endovascular Procedures;
Humans;
Mortality;
Nicardipine;
Nimodipine;
Retrospective Studies;
Subarachnoid Hemorrhage*;
Vasospasm, Intracranial
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2017;19(3):155-161
- CountryRepublic of Korea
- Language:English
-
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.
