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. 2018 Dec 15;58(12):495-502.
doi: 10.2176/nmc.oa.2018-0212. Epub 2018 Nov 21.

Endovascular Treatment for Vasospasm after Aneurysmal Subarachnoid Hemorrhage Based on Data of JR-NET3

Hirotoshi Imamura  1 , Nobuyuki Sakai  1 , Tetsu Satow  2 , Koji Iihara  3 ; JR-NET investigators
Affiliations

Endovascular Treatment for Vasospasm after Aneurysmal Subarachnoid Hemorrhage Based on Data of JR-NET3

Hirotoshi Imamura et al. Neurol Med Chir (Tokyo). .

Abstract

Endovascular treatments for vasospasm after subarachnoid hemorrhage are typically performed for patients who are refractory to recommended medical therapies. We analyzed the current status of endovascular treatments based on the data of Japanese Registry of Neuroendovascular Therapy (JR-NET)3, and evaluated factors related to improvement of imaging findings and neurological condition, and to mechanical hemorrhage complications. We collected data of 1211 treatments performed from 2010 to 2014. Target vessels for treatments were anterior circulation (n = 1079), posterior circulation (n = 91), and both (n = 32); the distribution of vasospasm was the proximal vessel (n = 754) to the Circle of Willis, distal vessel (n = 329), and both (n = 119). Of the treatments, 948 cases (78.3%) were intra-arterial administration of vasodilators and 259 (21.4%) were percutaneous transluminal angioplasty (PTA); 879 cases were the first intervention. The treatment time from onset was within 3 h in 378 (31.2%) cases, between 3 and 6 h in 349 (28.8%) cases, and over 6 h in 245 (20.2%) cases. The statistically significant factors associated with improvement on imaging findings was the first treatment, and treatment within 3 h from onset compared with that after 6 h. Additionally, the first and early treatments after the symptoms were associated with significantly improved neurological condition. All complications of mechanical hemorrhage occurred along with PTA. The findings show that endovascular treatment for vasospasm was effective, especially for cases who suffered from symptomatic vasospasm with a short interval after onset.

Keywords: endovascular treatment; neurological improvement; vasospasm.

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Conflict of interest statement

Conflicts of Interest Disclosure

H. Imamura received Speakers’ Bureau/Honoraria from Medtronic Co. N. Sakai received Speakers’ Bureau/Honoraria from Otsuka Pharmaceutical Co, Stryker Co, Medtronic Co, Medico’s Hirata Co, and Biomedical Solutions Co, and research funding from Otsuka Pharmaceutical Co, Terumo Co, and Daiichi Sankyo Co. K. Iihara received Speakers’ Bureau/Honoraria from Otsuka Pharmaceutical Co, and research funding from Otsuka Pharmaceutical Co, Mitsubishi Tanabe Pharma Co, Kaneka Medix Co, Chugai Pharmaceutical Co, and Eizai Co. T. Sato has no conflicts of interest to declare. All authors who are members of the Japan Neurosurgical Society (JNS) have registered online self-reported conflicts of interest disclosure statement forms through the website for JNS members.

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