Abstract
The cause of severe clinical vasospasm after aneurysmal subarachnoid haemorrhage remains by large a mystery, despite tremendous scientific efforts over the past three decades. However, transluminal balloon angioplasty and the intraarterial administration of vasodilatating agents represent successful tools in treating severe refractory cerebral vasospasm. Out of 350 patients admitted with acute SAH to our Medical Center over the past 2 years, 47 patients developed severe clinical vasospasm, requiring endovascular therapy. A total of 175 intraarterial nicardipine or verapamil injections were performed, while balloon angioplasty was performed in 49 vessels. There was significant (p<0.001, paired t-test) improvement of cerebral vasospasm after the intraarterial infusion of high dose verapamil or nicardipine over a period of 24–48 h. However, the administration of a vasodilatating agent followed by angioplasty represents a safe and long lasting therapy of severe clinical significant vasospasm (p<0.001, paired t-test). With current advances in endovascular technologies, balloon angioplasty along with administration of vasodilatating agents is safe and reduces the morbidity and mortality after subarachnoid haemorrhage.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Allen GS, Ahn HS, Preziosi TJ, et al (1983) Cerebral arterial spasm: a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 308: 619–624
Badjatia Neeraj, Topcuoglu MA (2004) Preliminary experience with intra-arterial nicardipine as a treatment for cerebral vasospasm. Am J Neuroradiol 25: 819–826
Haley EC, Kassell NF, Torner JC, et al (1993) A randomized controlled trial of high-dose intravenous nicardipine in aneurysmal subarachnoid hemorrhage: a report of the cooperative aneurysm study. J Neurosurg 78: 537–547
Haley EC, Kassell NF, Torner JC, Truskowski LL, Germanson TP, et al (1994) A randomized trial of two doses of nicardipine in aneurysmal subarachnoid hemorrhage: a report of the cooperative aneurysm study. J Neurosurg 80: 788–796
Hoh BL, Ogilvy CS (2005) Endovascular treatment of cerebral vasospasm: transluminal balloon angioplasty, intra-arterial-papaverine, and intra-arterial nicardipine. 16(3): 501–516
Joshi S, Young WL, Pile-Spellman J, et al (1997) Manipulation of cerebrovascular resistance during internal carotid artery occlusion by intraarterial verapamil. Anesth Analg 85: 753–759
Kohno H, Kawano T, Tanaka N, Honma T (1993) High dose nicardipine therapy for delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Nov 21(11): 999–1003
Lei Feng, Brian-Fred Fitzsimmons (2002) Intraarterially administered verapamil as adjunct therapy for cerebral vasospasm: safety and 2-year experience. AJNR 23: 1284–1290
Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P (1988) Cerebral vasospasm after subarachnoid hemorrhage inves-tigated by means of transcranial Doppler ultrasound. Acta Neurochirurgica Suppl (Wein) 42: 81–84
Macdonald RL, Weir B (2004) Epidemiology in cerebral vasospasm. Ca Academic Press, San Diego, pp 16–18
Macdonald RL (2006) Management of cerebral vasospasm. Neurosurg Rev 29(3): 179–193 (Epub)
Petruk KC, West M, et al (1988) Nimodipine treatment in poor-grade aneurysm patients: results of a multicenter double-blind placebo-controlled trial. J Neurosurg 68: 505–517
Polin R, Coenen V, Hansen CA, et al (2000) Efficacy of transluminal angioplasty for the management of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 92: 284–290
Takis C, Kwan ES, Pessin MS, Jacobs DH, Caplan LR (1997) Intracranial angioplasty: experience and complications. Am J Neuroradiol 18: 1661–1668
The American Society of Interventional and Therapeutic Neuroradiology (2001) Mechanical and pharmacologic treatment of vasospasm. Am J Neuroradiol 22: S26–S27
Zubkov YN, Nikiforov BM, Shustin VA (1984) Balloon catheter technique for dilation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochirur 70: 65–69
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Springer-Verlag
About this paper
Cite this paper
Delgado, A.L., Jahromi, B., Müller, N., Farhat, H., Salame, J., Zauner, A. (2008). Endovascular therapy of cerebral vasospasm: two year experience with angioplasty and/or intraarterial administration of nicardipine and verapamil. In: Kırış, T., Zhang, J.H. (eds) Cerebral Vasospasm. Acta Neurochirurgica Supplement, vol 104. Springer, Vienna. https://doi.org/10.1007/978-3-211-75718-5_72
Download citation
DOI: https://doi.org/10.1007/978-3-211-75718-5_72
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-75717-8
Online ISBN: 978-3-211-75718-5
eBook Packages: MedicineMedicine (R0)