Feasibility and safety of repeat instant endovascular interventions in patients with refractory cerebral vasospasms

Abstract

Background and Purpose: 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. MATERIALS AND METHODS: 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. RESULTS: During a4-yearperiod,365patientswithaneurysmalsubarachnoidhemorrhageweretreatedatourinstitution.Thirty-one(8.5%)met theinclusioncriteria.In52(14%)patients,-2endovascularinterventionswereperformedasrescuetherapyforrefractorycerebralvasospasm.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