Efficacy of endovascular treatment and feasibility of stent-assisted coiling in the presence of severe and symptomatic vasospasm.
OBJECTIVE
In patients with aneurysmal subarachnoid hemorrhage, deciding the optimal treatment strategy is challenging in the presence of severe and symptomatic vasospasm and the existing literature is limited. The purpose of this study was to evaluate the safety and effectiveness of endovascular treatment of intracranial aneurysms and the feasibility of stent-assisted coiling during severe and symptomatic vasospasm.


METHODS
Fifteen consecutive patients with 18 aneurysms who underwent endovascular treatment during severe and symptomatic vasospasm were included in the study. Patient and aneurysm characteristics, treatment technique, and clinical and angiographic outcomes were retrospectively evaluated.


RESULTS
Aneurysms were treated by the following techniques: single catheter coiling in 9, stent-assisted coiling in 8 (3 aneurysms with Y-configuration double stents), and balloon-assisted coiling in 1. All patients showed angiographic improvement of vasospasm after treatment including a noticeable dilation of the spastic parent arteries following deployment of the stents. According to the immediate post-treatment angiography results, 14 aneurysms (77.8%) had class I occlusion and 4 (22.2%) had class II occlusion. Three patients died during the course of subarachnoid hemorrhage. Mortality was related to the poor grade (Hunt and Hess grade V) and cardiovascular complications in two and refractory vasospasm one patient. The remaining patients had favorable clinical outcomes at follow-up (modified Rankin Scale 0-2).


CONCLUSIONS
Endovascular treatment of intracranial aneurysms during severe and symptomatic vasospasm is safe and effective. Stent-assisted coiling in the presence of severe vasospasm is also feasible in wide-necked aneurysms with the additional benefits of mechanical vasodilation.
Department of Radiology, Faculty of Medicine, Başkent University, Adana, Turkey.
Cagatay
http://orcid.org/0000-0001-8581-8685
C
Andic
Department of Neurosurgery, Faculty of Medicine, Başkent University, Adana, Turkey.
Ozgur
http://orcid.org/0000-0003-2854-941X
O
Kardes
Department of Neurosurgery, Faculty of Medicine, Başkent University, Adana, Turkey.
Emre
http://orcid.org/0000-0001-6939-5491
E
Durdag
Department of Radiology, Faculty of Medicine, Başkent University, Adana, Turkey.
Murat
http://orcid.org/0000-0002-9884-3190
M
Gedikoglu
Department of Anesthesiology and Reanimation, Faculty of Medicine, Başkent University, Adana, Turkey.
Sule
http://orcid.org/0000-0001-6423-1076
S
Akin
D000328:Adult; D000368:Aged; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000601:surgery*
Aneurysm; Hemorrhage; Stent; Subarachnoid