Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2007 Mar 15;13 Suppl 1(Suppl 1):48-52.
doi: 10.1177/15910199070130S105. Epub 2007 Jun 27.

Endovascular surgery for ruptured aneurysms with vasospasm

A Kurata  1 , S Suzuki, J Niki, H Ozawa, M Yamada, K Fujii, S Kan, T Kitahara, Y Miyasaka, T Ohmomo
Affiliations

Endovascular surgery for ruptured aneurysms with vasospasm

A Kurata et al. Interv Neuroradiol. .

Abstract

With the existence of vasospasm, it is recommended that direct clipping surgery for a ruptured aneurysm be delayed until its disappearance, but this may be associated with aneurysmal re-rupture resulting in a poor outcome for the patients. Indications for endovascular coil embolization in such cases are discussed. Since November in 2003, we have applied endovascular coil embolization in 11 consecutive patients with ruptured aneurysms and apparent vasospasm of the parent artery from two to 17 days (average: eight days) after initial subarachnoid hemorrhage. Three patients had aneurysmal re-rupture before treatment, but the other eight had only experienced the one episode of subarachnoid hemorrhage. With one exception, all endovascular procedures could be successfully performed, resulting in complete occlusion of aneurysms and remarkable dilatation of inserted spastic vessels without technical complications or aneurysmal re-rupture. For the one case of failure because of a tortuous artery, direct clipping surgery was performed after disappearance of vasospasm. Cerebral infarction occurred in four, but only one correlated with the distribution of catheterization, and neurological deficits had completely disappeared three months after the onset. This preliminary report concerning a small number of patients suggests that endovascular coil embolization is not contra-indicated for aneurysms with vasospasm requiring catheterization. A large study for confirmation is now warranted.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(Case 1) Left) and B) to right carotid angiogram showing a right anterior cerebral artery (ACA) aneurysm with vasospasm involving the right internal carotid artery and ACA. B) A right carotid angiogram after embolization showing complete obliteration of the aneurysm and remarkable dilatation of inserted spastic vessels.
Figure 2
Figure 2
(Case 2) Left) and B) to right carotid angiogram showing a right ACA aneurysm with vasospasm involving the right internal carotid artery and ACA. B) A right carotid angiogram after embolization showing complete obliteration of the aneurysm and remarkable dilatation of inserted spastic vessels.
See this image and copyright information in PMC

References

    1. Kassell NF, Torner JC, et al. The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results. J Neurosurg. 1990;73:18–36. - PubMed
    1. Torner JC, Kassell NF, et al. The timing of surgery and vasospasm. Neurosurgery Clinics of North America. 1990;1:335–347. - PubMed
    1. Weir B, Rothberg C, et al. Relative prognostic significance of vasospasm following subarachnoid hemorrhage. Can J Neurol Sci. 1975;2:109–114. - PubMed
    1. Brilstra EH, Rinkel GJE, et al. Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage. Neurology. 2000;55:1656–1660. - PubMed
    1. Findlay JM. A Canadian Neurosurgical Society practice guidelines review group: Current management of aneurysmal subarachnoid hemorrhage guidelines from the Canadian neurosurgical society. Can J Neurol Sci. 1997;24:161–170. - PubMed

LinkOut - more resources