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
. 2025 Mar 2:15910199251323003.
doi: 10.1177/15910199251323003. Online ahead of print.

Analysis of endovascular treatment for cerebral vasospasms after subarachnoid hemorrhage in the Japanese Registry of Neuroendovascular Therapy 4

Hisayuki Hosoo  1   2 , Hirotoshi Imamura  3   4 , Nobuyuki Sakai  4 , Koji Iihara  3 , Akira Ishii  5 , Chiaki Sakai  4 , Tetsu Satow  6 , Shinichi Yoshimura  7 , Yoshiro Ito  1   8 , Mikito Hayakawa  1   9 , Aiki Marushima  1   8 , Hiroshi Yamagami  1   2   10 , Yuji Matsumaru  1   8 ; JR-NET4 investigators
Affiliations

Analysis of endovascular treatment for cerebral vasospasms after subarachnoid hemorrhage in the Japanese Registry of Neuroendovascular Therapy 4

Hisayuki Hosoo et al. Interv Neuroradiol. .

Abstract

Background: This study aimed to evaluate the periprocedural and postprocedural outcomes of endovascular treatments for cerebral vasospasm after subarachnoid hemorrhage using data from the Japan Registry of Neuroendovascular Therapy 4 (JR-NET4) (2015-2019).

Methods: In this retrospective multicenter study, procedures of endovascular treatment for cerebral vasospasms registered in JR-NET4 were analyzed. The procedure outcomes and complications for percutaneous transluminal angioplasty (PTA) and intra-arterial administration of vasodilators (IA-vasodilator) were compared. The factors associated with imaging and symptom improvement were assessed.

Results: Analysis of 1549 procedures revealed that 83.5% of procedures were IA-vasodilator and 16.5% of procedures were PTA. Postprocedural imaging improvement was achieved in 97.0% of patients, and 50.1% of patients experienced symptomatic improvement. The overall complication rate was 1.6%. No significant differences were detected in overall complication rates between patients who underwent PTA and intra-arterial administration of vasodilators; however, hemorrhagic complications were significantly more frequent in patients who underwent PTA. Shorter intervals from symptom onset and the absence of periprocedural complications were associated with improved imaging and neurological outcomes. Local anesthesia and prior treatment with endovascular embolization for ruptured aneurysms were associated with enhanced neurological improvements.

Conclusion: Endovascular treatment for cerebral vasospasm is safe and effective. Factors such as early intervention and treatment under local anesthesia may contribute to neurological improvements. However, caution is warranted for PTA due to the slightly higher incidence of hemorrhagic complications.

Keywords: Cerebral vasospasm; endovascular treatment; local anesthesia; percutaneous transluminal angioplasty; ruptured aneurysms; subarachnoid hemorrhage; vasodilators; vasospasm.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interestsAll authors who are members and nonmembers of the Japan Neurosurgical Society (JNS) have registered self-reported COI disclosure statements through the JNS website. Nobuyuki Sakai reports research grants from Biomedical Solutions, Medtronic, Terumo, and TG Medical; lecturer's fees from Asahi-Intec, Biomedical Solutions, Daiichi Sankyo, Kaneka, Medtronic, and Terumo; membership on the advisory boards for Johnson & Johnson, Medtronic, and Terumo outside the submitted work. Koji Iihara reports research grants from Idorsia Pharmaceuticals Japan Co., Ltd. Outside submitted work. Dr Satow reports a research grant from CANON medical systems, a lecturer's fee from Medtronic, and a consulting fee from Kaneka Medix. Dr Yamagami discloses research grants from Bristol-Myers Squibb; lecturer's fees from Stryker, Medtronic, Johnson & Johnson, Medico's Hirata, Daiichi Sankyo, Bayer, and Otsuka Pharmaceutical; and membership of the advisory boards for Daiichi Sankyo. The other coauthors have no conflict of interest for this manuscript.

References

    1. Haley EC, Jr, Kassell NF, Torner JC. The international cooperative study on the timing of aneurysm surgery. The North American experience. Stroke 1992; 23: 205–214. - PubMed
    1. de Oliveira JG, Beck J, Ulrich C, et al. Comparison between clipping and coiling on the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Neurosurg Rev 2007; 30: 22–30. - PubMed
    1. Allen GS, Ahn HS, Preziosi TJ, et al. Cerebral arterial spasm--a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 1983; 308: 619–624. - PubMed
    1. Rinkel GJ, Feigin VL, Algra A, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2005: Cd000277. - PubMed
    1. Shibuya M, Suzuki Y, Sugita K, et al. Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Results of a prospective placebo-controlled double-blind trial. J Neurosurg 1992; 76: 571–577. - PubMed

LinkOut - more resources