The effect of endovascular therapy for cerebral arterial spasm, its limitation and pitfalls.
OBJECTIVE
The effect of endovascular treatment for vasospasm was investigated by analysing the results of patients treated in Wakayama City in 1994.


METHODS
Ninety nine patients with ruptured cerebral aneurysms, who survived more than one week and were treated in Wakayama City in 1994, were studied. Twenty five patients caused symptomatic vasospasm and 25 were treated by endovascular therapy, percutaneous transluminal angioplasty (PTA) and/or intra-arterial papaverine infusion (IAP). PTA was performed for proximal vasospasm which located in the main arterial trunk, such as ICA, M1, BA (n = 3). IAP was chosen for distal vasospasm which located mainly in the M2, A1, A2 (n = 12). PTA and/or IAP was performed for diffuse vasospasm which located in proximal and distal arteries (n = 10).


RESULTS
In the proximal vasospasm group, all patients were good to moderately disabled on the Glasgow outcome scale (GOS). In the distal vasospasm group, 8 patients were good to moderately disabled, and 4 patients were severely disabled. The overall results were as follows: 17 (68%), good to moderately disabled, 4 (16%), severely disabled, 4 (16%), dead. The morbidity and mortality rate was 8/25 (32%) in symptomatic spasm group.


CONCLUSIONS
PTA was very effective especially for proximal vasospasm, but IAP was not always effective for distal or diffuse vasospasm. Diffuse vasospasm revealed a high mortality rate in spite of the endovascular therapy.
Terada
T
T
Department of Neurological Surgery, Wakayama Medical College, Japan.
Kinoshita
Y
Y
Yokote
H
H
Tsuura
M
M
Nakai
K
K
Itakura
T
T
Hyotani
G
G
Kuriyama
T
T
Naka
Y
Y
Kido
T
T
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000800:Angioplasty, Balloon; D002533:Cerebral Angiography; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010208:Papaverine / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D014665:Vasodilator Agents; D010208:Papaverine