title: Efficacy of endovascular surgery for ruptured aneurysms with vasospasm of the parent artery.
abstract: BACKGROUND
  In the presence of vasospasm it is recommended that surgical clipping for a ruptured aneurysm should be delayed until it disappears, but this may be associated with re-rupture of the aneurysm resulting in a poor outcome. The indications for endovascular coil embolization in such cases are discussed.
  
  
  METHODS
  Since November 2002, endovascular coil embolization has been used in 18 consecutive patients with ruptured aneurysm with vasospasm of the parent artery ranging from 2 to 28 days (mean 9 days) after the initial subarachnoid hemorrhage. After successful obliteration of the aneurysm, a microcatheter preceded by a guidewire was introduced into the peripheral vessels with vasospasm of the A2 or M2 portions in order to release the vasospasm mechanically.
  
  
  RESULTS
  Endovascular procedures were performed successfully in all but one of the cases (94%), resulting in complete occlusion in 14 of 17 patients and mild dilation of the vasospasm in all 17 patients without technical complications or re-rupture of the aneurysm. In the one case of failure because of a tortuous artery, surgical clipping was performed after disappearance of the vasospasm. Cerebral infarction occurred in four patients, but only one correlated with the distribution of catheterization and the neurological deficits had completely disappeared 3 months after the onset.
  
  
  CONCLUSIONS
  Catheterization of parent vessels in cases of vasospasm is safe for coiling and also mechanically releases vasospasm. Vasospasm of M2 and A2 segments can be treated with microcatheterization only.
authors: Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan. akirak@med.kitasato-u.ac.jp
authors: Akira
authors: A
authors: Kurata
authors: Sachio
authors: S
authors: Suzuki
authors: Kazuhisa
authors: K
authors: Iwamoto
authors: Madoka
authors: M
authors: Inukai
authors: Kuniaki
authors: K
authors: Nakahara
authors: Kimitoshi
authors: K
authors: Satou
authors: June
authors: J
authors: Niki
authors: Makoto
authors: M
authors: Sasaki
authors: Kiyotaka
authors: K
authors: Fujii
authors: Shiichi
authors: S
authors: Kan
authors: Takao
authors: T
authors: Kitahara
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000601:surgery*; D017130:Angioplasty; D020771:Anterior Cerebral Artery / Q000473:pathology / Q000601:surgery; D001037:Aphasia / Q000209:etiology; D002404:Catheterization; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology / Q000601:surgery; D010291:Paresis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000150:complications / Q000601:surgery*