Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm.
The second leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (SAH) is delayed cerebral ischemia due to vasospasm. Although up to 70% of patients have been shown to have angiographic evidence of vasospasm, only 20-30% will present with clinical changes, including mental status changes and neurological deficits that necessitate acute management. Endovascular capabilities have progressed to become viable options in the treatment of cerebral vasospasm. The rationale for intraarterial therapy includes the fact that morbidity and mortality rates have not changed in recent years despite optimized noninvasive medical care. In this report, the authors discuss the most common endovascular options-namely intraarterial vasodilators and transluminal balloon angioplasty-from the standpoint of mechanism, efficacy, limitations, and complications as well as the treatment algorithms for cerebral vasospasm used at our institution.
Eddleman
Christopher S
CS
Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Hurley
Michael C
MC
Naidech
Andrew M
AM
Batjer
H Hunt
HH
Bendok
Bernard R
BR
D000800:Angioplasty, Balloon / Q000379:methods*; D002545:Brain Ischemia / Q000150:complications / Q000209:etiology / Q000628:therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002533:Cerebral Angiography / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D009422:Nervous System Diseases / Q000150:complications / Q000209:etiology / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000628:therapy; D020301:Vasospasm, Intracranial / Q000150:complications
D002121:Calcium Channel Blockers