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Clin Neurol Neurosurg. 2014 Mar;118:26-31. doi: 10.1016/j.clineuro.2013.12.012. Epub 2014 Jan 4.

Endovascular management of cerebral vasospasm following aneurysm rupture: outcomes and predictors in 116 patients.

Author information

1
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA.
2
Department of Neurosurgery, University of Iowa, Iowa City, USA.
3
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, USA. Electronic address: pascal.jabbour@jefferson.edu.

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.

CONCLUSION:

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.

KEYWORDS:

Aneurysm; Balloon angioplasty; Nicardipine; Vasospasm

PMID:
24529225
DOI:
10.1016/j.clineuro.2013.12.012
[Indexed for MEDLINE]

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