Combined endovascular treatment for both intracranial aneurysm and symptomatic vasospasm.
OBJECTIVE
The best strategy for treatment of subarachnoid hemorrhage due to ruptured cerebral aneurysm is obliteration of the aneurysm as soon as possible. Early surgery is desirable if the patient does not develop severe vasospasm or is clinically stable. However, if the patient has already developed severe vasospasm on admission, surgery may carry the risk of increasing the severity. We evaluated the safety and effectiveness of combined Guglielmi detachable coil (GDC) embolization and angioplasty in a single session for the treatment of ruptured aneurysms associated with symptomatic vasospasm.


METHODS
From January 1992 to January 2001, 12 consecutive patients with ruptured aneurysms associated with symptomatic vasospasm were treated. Patients were classified as Hunt and Hess grade 2 (n = 1), 3 (n = 6), 4 (n = 4), or 5 (n = 1) and Fisher CT group 2 (n = 1), 3 (n = 10), or 4 (n = 1). They underwent GDC aneurysm occlusion and balloon angioplasty (n = 6), intraarterial papaverine infusion (n = 2), or both (n = 4) in a single session. In nine patients, aneurysm coil occlusion was performed first.


RESULTS
Complete GDC occlusion was achieved in eight patients, a small neck remnant persisted in three, and embolization was incomplete in one patient. In all patients, angiographic improvement of vasospasm was obtained. In one patient, a thromboembolic complication occurred and was treated with urokinase. Clinical outcomes at discharge were good recovery in six, moderate disability in two, severe disability in three, or death in one.


CONCLUSIONS
Endovascular treatment can be the first therapeutic option for ruptured aneurysms associated with severe vasospasm on admission. It offers some advantages over surgery in this setting, but these are balanced by the risk of thromboembolism.
Murayama
Yuichi
Y
Division of Interventional Neuroradiology, Department of Radiology, University of California at Los Angeles, School of Medicine and Medical Center, Los Angeles, 90024, USA.
Song
Joon K
JK
Uda
Ken
K
Gobin
Y Pierre
YP
Duckwiler
Gary R
GR
Tateshima
Satoshi
S
Patel
Aman B
AB
Martin
Neil A
NA
Viñuela
Fernando
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D000800:Angioplasty, Balloon; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010208:Papaverine / Q000008:administration & dosage*; D012008:Recurrence; D019233:Retreatment; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000628:therapy*
D010208:Papaverine