Endovascular Treatment of Symptomatic Vasospasm after Aneurysmal Subarachnoid Hemorrhage: A Three-year Experience

Abstract

Objective : The cause of severe clinical vasospasm after aneurysmal sub-arachnoid hemorrhage remains unknown, despite extensive research over the past 30 years. However, the intra-arterial administration of vaso-dilating agents and balloon angioplasty have been successfully used in severe refractory cerebral vasospasm. Materials and Methods : We retrospectively analyzed the data of 233 pa-tients admitted to our institute with aneurysmal subarachnoid hemorrhage (SAH) over the past 3 years. Results : Of these, 27 (10.6%) developed severe symptomatic vasospasm, requiring endovascular therapy. Vasospasm occurred at an average of 5.3 days after SAH. A total of 46 endovascular procedures were performed in 27 patients. Endovascular therapy was performed once in 18 (66.7%) patients, 2 times in 4 (14.8%) patients, 3 or more times in 5 (18.5%) patients. Intra-arterial vasodilating agents were used in 44 procedures (27 with ni-modipine infusion, 17 with nicardipine infusion). Balloon angioplasty was performed in only 2 (7.4%) patients. The Average nimodipine infusion vol-ume was 2.47 mg, and nicardipine was 3.78 mg. Most patients recovered after the initial emergency room visit. Two patients (7.4%) worsened, but there were no deaths. Conclusion : With advances in endovascular techniques, administration of vasodilating agents and balloon angioplasty reduces the morbidity and mortality of vasospasm after aneurysmal SAH.