title: Prophylactic thrombosis to prevent new bleeding and to delay aneurysm surgery.
abstract: Six aneurysms in five patients with acute aneurysmal subarachnoid hemorrhages were treated with direct thrombosis using cellulose acetate polymer within 4 hours of rupture. The aneurysms involved the internal carotid and posterior communicating arteries (two patients), the anterior choroidal artery (one patient), the bifurcation of the basilar artery (one patient), and the middle cerebral artery (two patients). Four patients underwent aggressive volume expansion after direct thrombosis with cellulose acetate polymer. The aneurysms remained thrombosed until operations on the necks were performed 2 to 7 weeks after the subarachnoid hemorrhages. Three patients were given intrathecal tissue plasminogen activator. One patient, who remained at neurological Grade V, was not treated surgically and died from cardiac failure. Five aneurysms in the remaining four patients were successfully clipped. These preliminary data suggest that immediate aneurysmal thrombosis, then aggressive preoperative prophylactic volume expansion and/or administration of intrathecal tissue plasminogen activator, can help prevent new bleeding and reduce delayed cerebral ischemia in patients after aneurysmal subarachnoid hemorrhages.
authors.affiliation: Department of Neurological Surgery, Okayama University Medical School, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kinugasa
authors.forename: S
authors.initials: S
authors.lastname: Mandai
authors.forename: I
authors.initials: I
authors.lastname: Kamata
authors.forename: K
authors.initials: K
authors.lastname: Tokunaga
authors.forename: K
authors.initials: K
authors.lastname: Sugiu
authors.forename: A
authors.initials: A
authors.lastname: Handa
authors.forename: H
authors.initials: H
authors.lastname: Nakashima
authors.forename: T
authors.initials: T
authors.lastname: Ohmoto
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D002482:Cellulose / Q000031:analogs & derivatives; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011108:Polymers; D011300:Preoperative Care; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D011108:Polymers; C005062:acetylcellulose; D002482:Cellulose