title: Invasive interventional management of post-hemorrhagic cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage.
abstract: Current clinical practice standards are addressed for the invasive interventional management of post-hemorrhagic cerebral vasospasm (PHCV) in patients with aneurysmal subarachnoid hemorrhage. The conclusions, based on an assessment by the Standards Committee of the Society of Neurointerventional Surgery, included a critical review of the literature using guidelines for evidence based medicine proposed by the Stroke Council of the American Heart Association and the University of Oxford, Centre for Evidence Based Medicine. Specifically examined were the safety and efficacy of established invasive interventional therapies, including transluminal balloon angioplasty (TBA) and intra-arterial vasodilator infusion therapy (IAVT). The assessment shows that these invasive interventional therapies may be beneficial and may be considered for PHCV-that is, symptomatic with cerebral ischemia and refractory to maximal medical management. As outlined in this document, IAVT may be beneficial for the management of PHCV involving the proximal and/or distal intradural cerebral circulation. TBA may be beneficial for the management of PHCV that involves the proximal intradural cerebral circulation. The assessment shows that for the indications described above, TBA and IAVT are classified as Class IIb, Level B interventions according to the American Heart Association guidelines, and Level 4, Grade C interventions according to the University of Oxford Centre for Evidence Based Medicine guidelines.
authors.affiliation: Department of Neurosurgery, University of Cincinnati and Mayfield Clinic, Cincinnati, USA. todd.abruzzo@healthall.com
authors.forename: Todd
authors.initials: T
authors.lastname: Abruzzo
authors.forename: Christopher
authors.initials: C
authors.lastname: Moran
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Blackham
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Eskey
authors.forename: Raisa
authors.initials: R
authors.lastname: Lev
authors.forename: Philip
authors.initials: P
authors.lastname: Meyers
authors.forename: Sandra
authors.initials: S
authors.lastname: Narayanan
authors.forename: Charles Joseph
authors.initials: CJ
authors.lastname: Prestigiacomo
mesh_terms: D000800:Angioplasty, Balloon / Q000592:standards; D006801:Humans; D007261:Infusions, Intra-Arterial; D019635:Neurosurgical Procedures; D012015:Reference Standards; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000628:therapy*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*
chemical_list: D014665:Vasodilator Agents