Severe cerebral vasospasm in chronic cocaine users during neurointerventional procedures: A report of two cases.
Cocaine is a widespread recreational drug that has the potential to induce neurological vascular diseases, including ischaemic and haemorrhagic stroke. Although arterial vasospasm has been suggested as a pathogenic factor in the development of neurovascular complications, it remains unclear whether cocaine users carry an increased risk to suffer iatrogenic vasospasm during endovascular procedures. We report the case of two patients with a history of cocaine abuse, who developed unusual severe vasospasms during different interventional procedures. The first case occurred in a middle-aged woman with an unruptured left internal carotid artery bifurcation aneurysm who was scheduled for treatment by remodelling assisted coiling. Just after the placement of the remodelling balloon, a severe occlusive vasospasm interrupted the procedure. The second case happened to a 46-year-old man with a non-aneurysmal subarachnoid haemorrhage and a symptomatic vasospasm in the right-sided anterior circulation who developed another occlusive vasospasm after the first attempt at transluminal balloon angioplasty. Further research is needed to establish a relation between cocaine use and increased risk of iatrogenic vasospasm in endovascular procedures, but we suggest practitioners be extremely cautious when treating this subgroup of patients.
Interventional Neuroradiology Unit, Hospital Clínico Universitario, Valladolid, Spain Department of Radiology and Stroke Unit, Department of Neurology, Hospital Clínico Universitario,Valladolid, Spain pablogbermejo@hotmail.com.
Pablo
P
García-Bermejo
Department of Neurosurgery, Hospital Clínico Universitario, Valladolid, Spain.
Carlos
C
Rodríguez-Arias
Interventional Neuroradiology Unit, Hospital Clínico Universitario, Valladolid, Spain.
Eduardo
E
Crespo
Interventional Neuroradiology Unit, Hospital Clínico Universitario, Valladolid, Spain.
Santiago
S
Pérez-Fernández
Department of Radiology and Stroke Unit, Department of Neurology, Hospital Clínico Universitario,Valladolid, Spain.
Juan F
JF
Arenillas
Interventional Neuroradiology Unit, Hospital Clínico Universitario, Valladolid, Spain.
Mario
M
Martínez-Galdámez
D000328:Adult; D002908:Chronic Disease; D019970:Cocaine-Related Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012720:Severity of Illness Index; D020301:Vasospasm, Intracranial / Q000209:etiology*
Cocaine; endovascular treatment; stroke; vasospasm