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. 2010 Nov;31(10):1911-6.
doi: 10.3174/ajnr.A2183. Epub 2010 Jul 8.

Endovascular treatment of medically refractory cerebral vasospasm following aneurysmal subarachnoid hemorrhage

P Jun  1 , N U Ko, J D English, C F Dowd, V V Halbach, R T Higashida, M T Lawton, S W Hetts
Affiliations

Endovascular treatment of medically refractory cerebral vasospasm following aneurysmal subarachnoid hemorrhage

P Jun et al. AJNR Am J Neuroradiol. 2010 Nov.

Abstract

Background and purpose: CV following aneurysmal SAH is a significant cause of morbidity and mortality. We review our experiences using PTA and IA verapamil infusion for treating medically refractory cases.

Materials and methods: We performed a retrospective review of patients with SAH admitted from July 2003 to January 2008.

Results: Of 546 patients admitted within 72 hours of symptom onset, 231 patients (42%) developed symptomatic CV and 189 patients (35%) required endovascular therapy. A total of 346 endovascular sessions were performed consisting of 1 single angioplasty, 286 IA verapamil infusions, and 59 combined treatments. PTA was performed on 151 vessel segments, and IA verapamil was infused in 720 vessel segments. IA verapamil doses ranged from 2.0 to 30.0 mg per vessel segment and from 3.0 to 55.0 mg per treatment session. Repeat treatments were necessary in 102 patients (54%) for persistent, recurrent, or worsening CV. There were 6 treatment-related complications, of which 2 resulted in clinical worsening. No deaths were attributable to endovascular therapy. At follow-up, 115 patients (61%) had a good outcome and 55 patients (29%) had a poor outcome. Sixteen patients died from causes related to SAH, while 3 died from other medical complications.

Conclusions: Endovascular treatments are an integral part of managing patients with medically refractory CV. In our experience, PTA and IA verapamil are safe, with a low complication rate, but further studies are required to determine appropriate patient selection and treatment efficacy.

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Figures

Fig 1.
Fig 1.
Selection of the study population from July 2003 to January 2008.
Fig 2.
Fig 2.
Longitudinal clinical outcomes. Differences between good (HH scores, 1–3) and poor (HH scores, 4 and 5) clinical presentation groups are significantly different for all outcome measures (χ2 = 32, df = 2, P < .001).
Fig 3.
Fig 3.
IA verapamil dose by CV severity. Only IA infusions into the ICA and vertebral arteries are considered (n = 680, 94% of total vessel segments infused). X indicates the median verapamil dose.
See this image and copyright information in PMC

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