Endovascular treatment of medically refractory cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
OBJECTIVE
CV following aneurysmal SAH is a significant cause of morbidity and mortality. We review our experiences using PTA and IA verapamil infusion for treating medically refractory cases.


METHODS
We performed a retrospective review of patients with SAH admitted from July 2003 to January 2008.


RESULTS
Of 546 patients admitted within 72 hours of symptom onset, 231 patients (42%) developed symptomatic CV and 189 patients (35%) required endovascular therapy. A total of 346 endovascular sessions were performed consisting of 1 single angioplasty, 286 IA verapamil infusions, and 59 combined treatments. PTA was performed on 151 vessel segments, and IA verapamil was infused in 720 vessel segments. IA verapamil doses ranged from 2.0 to 30.0 mg per vessel segment and from 3.0 to 55.0 mg per treatment session. Repeat treatments were necessary in 102 patients (54%) for persistent, recurrent, or worsening CV. There were 6 treatment-related complications, of which 2 resulted in clinical worsening. No deaths were attributable to endovascular therapy. At follow-up, 115 patients (61%) had a good outcome and 55 patients (29%) had a poor outcome. Sixteen patients died from causes related to SAH, while 3 died from other medical complications.


CONCLUSIONS
Endovascular treatments are an integral part of managing patients with medically refractory CV. In our experience, PTA and IA verapamil are safe, with a low complication rate, but further studies are required to determine appropriate patient selection and treatment efficacy.
Jun
P
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Departments of Radiology, University of California, San Francisco, 94143-0628, USA.
Ko
N U
NU
English
J D
JD
Dowd
C F
CF
Halbach
V V
VV
Higashida
R T
RT
Lawton
M T
MT
Hetts
S W
SW
D000328:Adult; D017130:Angioplasty / Q000009:adverse effects; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000209:etiology*; D014700:Verapamil / Q000008:administration & dosage* / Q000009:adverse effects
D014665:Vasodilator Agents; D014700:Verapamil