title: Feasibility and Safety of Repeat Instant Endovascular Interventions in Patients with Refractory Cerebral Vasospasms.
abstract: For patients with cerebral vasospasm refractory to medical and hemodynamic therapies, endovascular therapies often remain the last resort. Data from studies in large cohorts on the efficacy and safety of multiple immediate endovascular interventions are sparse. Our aim was to assess the feasibility and safety of multiple repeat instant endovascular interventions in patients with cerebral vasospasm refractory to medical, hemodynamic, and initial endovascular interventions.
  
  
  
  This was a single-center retrospective study of prospectively collected data on patients with cerebral vasospasm refractory to therapies requiring ≥3 endovascular interventions during the course of treatment following aneurysmal subarachnoid hemorrhage. The primary end point was functional outcome at last follow-up (mRS ≤2). The secondary end point was angiographic response to endovascular therapies and the appearance of cerebral infarctions.
  
  
  
  During a 4-year period, 365 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Thirty-one (8.5%) met the inclusion criteria. In 52 (14%) patients, ≤2 endovascular interventions were performed as rescue therapy for refractory cerebral vasospasm. At last follow-up, a good outcome was noted in 18 (58%) patients with ≥3 interventions compared with 31 (61%) of those with ≤2 interventions (P= .82). The initial Hunt and Hess score of ≤2 was a significant independent predictor of good outcome (OR, 4.7; 95% CI, 1.2-18.5;P= .03), whereas infarcts in eloquent brain areas were significantly associated with a poor outcome (mRS 3-6; OR, 13.5; 95% CI, 2.3-81.2;P= .004).
  
  
  
  Repeat instant endovascular intervention is an aggressive but feasible last resort treatment strategy with a favorable outcome in two-thirds of patients with refractory cerebral vasospasm and in whom endovascular treatment has already been initiated.
authors.affiliation: From the Department of Neurosurgery (L.A., J.B., W.J.Z., R.H.A., M.M., M.R., A.R.).|Institute for Diagnostic and Interventional Neuroradiology (L.A., G.S., J.G.).
authors.forename: L
authors.identifier: 0000-0003-1764-688X
authors.initials: L
authors.lastname: Andereggen
authors.affiliation: From the Department of Neurosurgery (L.A., J.B., W.J.Z., R.H.A., M.M., M.R., A.R.).
authors.forename: J
authors.identifier: 0000-0002-7687-6098
authors.initials: J
authors.lastname: Beck
authors.affiliation: From the Department of Neurosurgery (L.A., J.B., W.J.Z., R.H.A., M.M., M.R., A.R.).|Departments of Neurology (W.J.Z.).
authors.forename: W J
authors.identifier: 0000-0002-5684-4419
authors.initials: WJ
authors.lastname: Z'Graggen
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology (L.A., G.S., J.G.).
authors.forename: G
authors.identifier: 0000-0002-5264-9405
authors.initials: G
authors.lastname: Schroth
authors.affiliation: From the Department of Neurosurgery (L.A., J.B., W.J.Z., R.H.A., M.M., M.R., A.R.).
authors.forename: R H
authors.identifier: 0000-0003-4485-8968
authors.initials: RH
authors.lastname: Andres
authors.affiliation: From the Department of Neurosurgery (L.A., J.B., W.J.Z., R.H.A., M.M., M.R., A.R.).
authors.forename: M
authors.identifier: 0000-0002-9874-1135
authors.initials: M
authors.lastname: Murek
authors.affiliation: Intensive Care Medicine (M.H.), Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: M
authors.identifier: 0000-0001-5845-031X
authors.initials: M
authors.lastname: Haenggi
authors.affiliation: From the Department of Neurosurgery (L.A., J.B., W.J.Z., R.H.A., M.M., M.R., A.R.).
authors.forename: M
authors.identifier: 0000-0002-0971-9543
authors.initials: M
authors.lastname: Reinert
authors.affiliation: From the Department of Neurosurgery (L.A., J.B., W.J.Z., R.H.A., M.M., M.R., A.R.).
authors.forename: A
authors.identifier: 0000-0002-3886-466X
authors.initials: A
authors.lastname: Raabe
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology (L.A., G.S., J.G.) jan.gralla@insel.ch.
authors.forename: J
authors.identifier: 0000-0003-1953-9033
authors.initials: J
authors.lastname: Gralla
mesh_terms: D000328:Adult; D000368:Aged; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000601:surgery*