title: Endovascular management of cerebral vasospasm following aneurysm rupture: outcomes and predictors in 116 patients.
abstract: OBJECTIVE
  To retrospectively assess the safety and efficacy of endovascular treatment of cerebral vasospasm with different modalities and assess predictors of outcome.
  
  
  METHODS
  Endovascular treatment was indicated in the event of neurological deterioration refractory to medical therapy. Data were collected for 116 patients treated at our institution.
  
  
  RESULTS
  Vasospasm was treated with balloon angioplasty in 52.6%, intra-arterial nicardipine infusion in 19.8%, or both in 27.6%. Angiographic vasospasm was reversed in all but 4 (96.6%) patients. The complication rate was 0.9%. Twenty patients (17.2%) had incipient pre-procedure hypodensities; 3 (15%) hypodensities were reversed and neurological improvement occurred in 60% of these patients. Retreatment was required in 22 (19%) patients. Higher Hunt and Hess grades and treatment with nicardipine alone predicted retreatment. Neurological improvement was noted in 82%. Male gender, pre-procedure hypodensities, and posterior communicating artery aneurysm location negatively predicted neurological recovery. Favorable outcomes were noted in 73%. Higher Hunt and Hess grades, pre-procedure hypodensities, posterior circulation aneurysms, and no neurological recovery predicted poor outcome.
  
  
  CONCLUSIONS
  Endovascular therapy for vasospasm has an excellent safety-efficacy profile. Balloon angioplasty and nicardipine are equally effective but effects of nicardipine are less durable. Patients with incipient pre-procedure hypodensities benefit from endovascular intervention and should probably not be excluded from treatment.
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors: Nohra
authors: N
authors: Chalouhi
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors: Stavropoula
authors: S
authors: Tjoumakaris
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors: Vismay
authors: V
authors: Thakkar
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors: Thana
authors: T
authors: Theofanis
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors: Christine
authors: C
authors: Hammer
authors: Department of Neurosurgery, University of Iowa, Iowa City, USA.
authors: David
authors: D
authors: Hasan
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors: Robert M
authors: RM
authors: Starke
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors: Chengyuan
authors: C
authors: Wu
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors: L Fernando
authors: LF
authors: Gonzalez
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
authors: Robert
authors: R
authors: Rosenwasser
authors: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA. Electronic address: pascal.jabbour@jefferson.edu.
authors: Pascal
authors: P
authors: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002544:Cerebral Infarction / Q000209:etiology; D003131:Combined Modality Therapy; D003627:Data Interpretation, Statistical; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000627:therapeutic use; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000628:therapy*; D055815:Young Adult
chemical_list: D002121:Calcium Channel Blockers; D009529:Nicardipine
keywords: Aneurysm; Balloon angioplasty; Nicardipine; Vasospasm