Mechanical treatment of vasospasm.
OBJECTIVE
Since cerebral vasospasm (CV) was first described nearly half a century ago, significant progress has been made in understanding its underlying pathophysiology and developing treatment modalities. The purpose of this review is to discuss the rationale behind mechanical interventions for CV as well as the efficacy and complications associated with these treatment options.


METHODS
The authors summarize the pertinent literature on the mechanical treatment of CV, focusing first on balloon angioplasty, second on therapy combined with intra-arterial drug infusion, and concluding by briefly discussing intra-aortic balloon counterpulsation. The epidemiology, pathophysiology, technique, outcome, timing and complications are discussed for each treatment option.


RESULTS
A review of the relevant medical literature reveals that in the last 20 years, endovascular techniques including transluminal balloon angioplasty, intra-arterial drug infusion and newer experimental strategies have provided an important supplement to the established medical therapy.


CONCLUSIONS
Despite these developments, however, CV remains a major contributor to poor outcome following aSAH and continued efforts are necessary to improve and refine endovascular strategies as well as develop new treatment modalities.
Haque
Raqeeb
R
Department of Neurological Surgery, Columbia University, College of Physicians and Surgeons, Neurological Institute of New York, New York 10032, USA.
Kellner
Christopher P
CP
Komotar
Ricardo J
RJ
Connolly
E Sander
ES
Lavine
Sean D
SD
Solomon
Robert A
RA
Meyers
Philip M
PM
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects / Q000379:methods; D007423:Intra-Aortic Balloon Pumping; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000517:prevention & control* / Q000628:therapy*