Therapeutic modalities for the management of cerebral vasospasm: timing of endovascular options.
OBJECTIVE
To determine if a window of time could be defined during which angioplasty would be most effective in reversing neurological decline and ultimately improving outcome.


METHODS
Of a group of 466 patients, 93 underwent endovascular management of clinical vasospasm that was medically refractory. Eighty-four of the 93 patients were available for follow-up for at least 6 months. All patients underwent mechanical angioplasty using compliant microballoon systems and, if distal spasm was present, the administration of papaverine.


RESULTS
Fifty-one patients underwent endovascular management within a 2-hour window, and 33 patients underwent treatment more than 2 hours after the development of their symptoms. Compared with the group treated more than 2 hours after neurological decline (P < 0.01; chi2 = 8.02), the group that underwent endovascular management within a 2-hour window after the development of symptoms demonstrated sustained clinical improvement.


CONCLUSIONS
When a patient develops symptomatic vasospasm and is unresponsive to traditional measures of critical care management, angioplasty may be effective in improving the patient's neurological status if this procedure is performed as early as possible. The results indicate that a 2-hour window may exist for restoration of blood flow to ultimately improve the patient's outcome.
Rosenwasser
R H
RH
Department of Neurosurgery, Thomas Jefferson University Hospital-Wills Neurosensory Institute, Philadelphia, Pennsylvania, USA.
Armonda
R A
RA
Thomas
J E
JE
Benitez
R P
RP
Gannon
P M
PM
Harrop
J
J
D000800:Angioplasty, Balloon; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D009420:Nervous System / Q000503:physiopathology; D010208:Papaverine / Q000627:therapeutic use; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D010208:Papaverine