Safety of hemodynamic augmentation in patients treated with Guglielmi detachable coils after acute aneurysmal subarachnoid hemorrhage.
OBJECTIVE
Guglielmi detachable coils (GDC) used in the treatment of intracranial aneurysms do not always completely occlude the aneurysm. Thus, after an acute subarachnoid hemorrhage (SAH), there is a theoretical risk of rebleeding from coiled aneurysms, especially when blood pressure is elevated. The aim of this study is to determine whether use of hemodynamic augmentation (HA) to treat delayed ischemic deficits (DID) will increase the risk of rebleeding in these patients.


METHODS
Delayed ischemic deficits developed in 12 (7 women and 5 men, aged 31 to 64 years) of 51 patients treated with GDC for acute SAH over a 4-year period. Aneurysms in all 12 patients were >/=80% obliterated with GDC, and there was >/=90% obliteration of 78% of the aneurysms. Hemodynamic augmentation with fluids, phenylephrine, dopamine, and/or dobutamine was used to treat DID for a mean duration of 3 days (range 1 to 11 days).


RESULTS
With HA, mean arterial blood pressure (MAP) rose 15% (range 0 to 30%) and systolic blood pressure (SBP) rose 13% (range 0 to 29%) above baseline. MAP was maintained at >10% above baseline for 65% of the treatment period. The maximum MAP was 104 to 170 mm Hg (mean 140 mm Hg), and maximum SBP was 154 to 261 mm Hg (mean 210 mm Hg). No patient had rebleeding or any significant complication during the course of therapy.


CONCLUSIONS
Based on this limited series of patients, we believe that it may be safe to use HA in patients treated with GDC for SAH.
Aiyagari
V
V
Neurology/Neurosurgery Intensive Care Unit, Department of Neurology Washington University School of Medicine, St Louis, MO, USA.
Cross
D T
DT
Deibert
E
E
Dacey
R G
RG
Diringer
M N
MN
D000208:Acute Disease; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy*; D002302:Cardiac Output / Q000187:drug effects; D004280:Dobutamine / Q000009:adverse effects / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D015600:Glasgow Coma Scale; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010656:Phenylephrine / Q000627:therapeutic use; D012008:Recurrence; D018570:Risk Assessment; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy
D010656:Phenylephrine; D004280:Dobutamine; D004298:Dopamine