Endovascular Treatment of Vasospasm

  • Pearse Morris


Cerebral vasospasm of the major arterial vessels at the base of the brain can occur acutely and usually transiently at the time of subarachnoid hemorrhage or in a delayed manner peaking at 10–14 days later. As a clinical problem vasospasm is most commonly encountered following aneurysmal subarachnoid hemorrhage, but can also be seen following other causes of bleeding including trauma, arteriovenous malformations, and tumors.1 The exact pathophysiology of vasospasm is uncertain but involves the products of clot degradation in the basal cisterns, especially oxyhemoglobin.2


Middle Cerebral Artery Subarachnoid Hemorrhage Endovascular Treatment Balloon Angioplasty Cerebral Vasospasm 
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  1. 1.
    Mayberg MR (1998) Cerebral vasospasm. Neurosurg Clin North Am 9: 615–627.Google Scholar
  2. 2.
    Dietrich HH, Dacey RG (2000) Molecular keys to the prob¬lems of cerebral vasospasm. Neurosurgery 46: 517–530.PubMedCrossRefGoogle Scholar
  3. 3.
    Pasqualin A (1998) Epidemiology and pathophysiology of 17. cerebral vasospasm following subarachnoid hemorrhage. J Neurosurg Sci 42: 15–21.PubMedGoogle Scholar
  4. 4.
    Findlay JM, Macdonald RL, Weir BK (1991) Current con¬cepts of pathophysiology and management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Cerebrovasc Brain Metabol Rev 3: 336–361.Google Scholar
  5. 5.
    Takenaka K, yamada H, sakai N, ando T, nakashima T Nishimura Y (1991) Induction of cytosolic free calcium elevation in rat vascular smooth-muscle cells by cerebrospinal fluid from patients after subarachnoid hemorrhage. J Neurosurg 75: 452–457.PubMedCrossRefGoogle Scholar
  6. 6.
    Wolf EW, Banerjee A, Soble-Smith J, Dohan FC Jr, White RP, Robertson JT (1998) Reversal of cerebral vasospasm us- ing an intrathecally administered nitric oxide donor. J Neu- rosurg 89: 279–288.Google Scholar
  7. 7.
    Thomas JE, Rosenwasser RH, Armonda RA, Harrop J, Mitchell W, Galaria I (1999) Safety of intrathecal sodium nitroprusside for the treatment and prevention of refractory cerebral vasospasm and ischemia in humans. Stroke 30: 1409–1416.PubMedCrossRefGoogle Scholar
  8. 8.
    Yamamoto S, Nishizawa S, Yokoyama T, Ryu H, Uemura K (1997) Subarachnoid hemorrhage impairs cerebral blood flow response to nitric oxide but not to cyclic GMP in large cerebral arteries. Brain Res 757: 1–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Levin ER (1995) Endothelins. N Engl J Med 333: 356–363.PubMedCrossRefGoogle Scholar
  10. 10.
    Juvela S (2000) Plasma endothelin concentrations after aneurysmal subarachnoid hemorrhage. J Neurosurg 92: 390–400.PubMedCrossRefGoogle Scholar
  11. 11.
    Alabadi JA, Torregrosa G, Miranda FJ, Salom JB, Centeno JM, Alborch E (1997) Impairment of the modulatory role of nitric oxide on the endothelin-1-elicited contraction of cerebral arteries: a pathogenetic factor in cerebral vasospasm after subarachnoid hemorrhage? Neurosurgery 41: 245–252.PubMedCrossRefGoogle Scholar
  12. 12.
    Sobey CG, Faraci FM (1998) Subarachnoid haemorrhage: what happens to the cerebral arteries? Clin Exp Pharmacol Physiol 25: 867–876.PubMedCrossRefGoogle Scholar
  13. 13.
    Kassell NF, Peerless SJ, Durward QJ, Beck DW, Drake CG, Adams HP (1982) Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11: 337–343.PubMedCrossRefGoogle Scholar
  14. 14.
    Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20.PubMedCrossRefGoogle Scholar
  15. 15.
    Pickard JD, Murray GD, Illingworth R, Shaw MD, Teasdale GM, Foy PM, Humphrey PR, Lang DA, Nelson R, Richards P, et al. (1989) Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. Br Med J 298: 636–642.CrossRefGoogle Scholar
  16. 16.
    Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL (1990) The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73: 18–36.PubMedCrossRefGoogle Scholar
  17. 17.
    Powers WJ, Grubb RL Jr, Baker RP, Mintun MA, Raichle ME (1985) Regional cerebral blood flow and metabolism in reversible ischemia due to vasospasm. Determination by positron emission tomography. J Neurosurg 62: 539546.Google Scholar
  18. 18.
    Lewis DH, Eskridge JM, Newell DW, Grady MS, Cohen WA, Dalley RW, Loyd D, Grothaus-King A, Young P, Winn HR (1992) Brain SPECT and the effect of cerebral angioplasty in delayed ischemia due to vasospasm. J Nucl Med 33: 1789–1796.PubMedGoogle Scholar
  19. 19.
    Fandino J, Kaku Y, Schuknecht B, Valavanis A, Yonekawa Y (1998) Improvement of cerebral oxygenation patterns and metabolic validation of superselective intraarterial infusion of papaverine for the treatment of cerebral vasospasm. J Neurosurg 89: 93–100.PubMedCrossRefGoogle Scholar
  20. 20.
    Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Winn HR, Richardson AE, Jane JA (1977) The long-term prognosis in untreated cerebral aneurysms: I. The incidence of late hemorrhage in cerebral aneurysm: a 10-year evaluation of 364 patients. Ann Neural 1: 358–370.CrossRefGoogle Scholar
  22. 22.
    Weir BK, Kongable GL, Kassell NF, Schultz JR, Truskowski LL, Sigrest A (1998) Cigarette smoking as a cause of aneurysmal subarachnoid hemorrhage and risk for vasospasm: a report of the Cooperative Aneurysm Study. J Neurosurg 89: 405–411.PubMedCrossRefGoogle Scholar
  23. 23.
    Lasner TM, Weil RJ, Riina HA, King JT Jr, Zager EL, Raps EC, Flamm ES (1997) Cigarette smoking-induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg 87: 381–384.PubMedCrossRefGoogle Scholar
  24. 24.
    Aaslid R, Markwalder TM, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57: 769–774.PubMedCrossRefGoogle Scholar
  25. 25.
    Bartels E, Fuchs HH, Flugel KA (1995) Color Doppler imaging of basal cerebral arteries: normal reference values and clinical applications. Angiology 46: 877–884.PubMedCrossRefGoogle Scholar
  26. 26.
    Lindegaard KF, Bakke SJ, Sorteberg W, Nakstad P, Nornes H (1986) A non-invasive Doppler ultrasound method for the evaluation of patients with subarachnoid hemorrhage. Acta Radiologica-Supplementum 369: 96–98, 1986Google Scholar
  27. 27.
    Vora YY, Suarez-Almazor M, Steinke DE, Martin ML, Findlay JM (1999) Role of transcranial Doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 44: 1237–1248.PubMedGoogle Scholar
  28. 28.
    Hughes JT, Schianchi PM (1978) Cerebral artery spasm. A histological study at necropsy of the blood vessels in cases of subarachnoid hemorrhage. J Neurosurg 48: 515–525.PubMedCrossRefGoogle Scholar
  29. 29.
    Smith RR, Clower BR, Grotendorst GM,Yabuno N, Cruse JM (1985) Arterial wall changes in early human vasospasm. Neurosurgery 16: 171–176.Google Scholar
  30. 30.
    Ohkawa M, Fujiwara N, Tanabe M, Takashima H, Satoh K, Kojima K, Irie K, Honjo Y, Nagao S (1996) Cerebral vasospastic vessels: histologic changes after percutaneous transluminal angioplasty. Radiology 198: 179–184.PubMedGoogle Scholar
  31. 31.
    Kobayashi H, Ide H, Aradachi H, Arai Y, Handa Y, Kubota T (1993) Histological studies of intracranial vessels in primates following transluminal angioplasty for vasospasm. J Neurosurg 78: 481–486.PubMedCrossRefGoogle Scholar
  32. 32.
    Fujiwara N, Ohkawa M, Tanabe M, Irie K, Nagao S (1994) The effect of PTA on cerebral vessels in experimental vaso-spasm: a histopathological study. Nippon Igaku Hoshasen Gakkai Zasshi-Nippon Acta Radiologica 54: 378–388.Google Scholar
  33. 33.
    Kazan S (1998) Effects of intra-arterial papaverine on the chronic period of cerebral arterial vasospasm in rats. Acta Neurologica Scandinavica 98: 354–359.PubMedCrossRefGoogle Scholar
  34. 34.
    Fujiwara N, Honjo Y, Ohkawa M, Tanabe M, Irie K, Nagao S, Takashima H, Satoh K, Kojima K (1997) Intraarterial infusion of papaverine in experimental cerebral vasospasm. AJNR 18: 255–262.PubMedGoogle Scholar
  35. 35.
    Milburn JM, Moran CJ, Cross DT3, Diringer MN, Pilgram TK, Dacey RGJ (1998) Increase in diameters of vasospastic intracranial arteries by intraarterial papaverine administration. J Neurosurg 88: 38–42.PubMedCrossRefGoogle Scholar
  36. 36.
    Nagai H, Noda S, Mare H (1975) Experimental cerebral vasospasm. Part 2: effects of vasoactive drugs and sympathectomy on early and late spasm. J Neurosurg 42: 420–428.PubMedCrossRefGoogle Scholar
  37. 37.
    Kuwayama A, Zervas NT, Shintani A, Pickren KS (1972) Papaverine hydrochloride and experimental hemorrhagic cerebral arterial spasm. Stroke 3: 27–33.PubMedCrossRefGoogle Scholar
  38. 38.
    Zubkov ŸN, Alexander LF, Smith RR, Benashvili GM, Semenyutin V, Bernanke D (1994) Angioplasty of vasospasm: is it reasonable? Neural Res 16: 9–11.Google Scholar
  39. 39.
    Kallmes DF, Jensen ME, Dion JE (1997) Infusing doubt into the efficacy of papaverine. AJNR 18: 263–264.PubMedGoogle Scholar
  40. 40.
    Polin RS, Hansen CA, German P, Chadduck JB, Kassell NF (1998) Intra-arterially administered papaverine for the treatment of symptomatic cerebral vasospasm. Neurosurgery 42: 1256–1264.PubMedCrossRefGoogle Scholar
  41. 41.
    Polin RS, Kassell NF (1998) Treatment of vasospasm. J Neurosurg 88: 933.PubMedGoogle Scholar
  42. 42.
    Eskridge JM, Newell DW, Winn HR (1994) Endovascular treatment of vasospasm. Neurosurg Clin North Am 5: 437–447.Google Scholar
  43. 43.
    Eskridge JM, Song JK (1997) A practical approach to the treatment of vasospasm. AJNR 18: 1653–1660.PubMedGoogle Scholar
  44. 44.
    Eskridge JM, Mcauliffe W, Song JK, Deliganis AV, Newell DW, Lewis DH, Mayberg MR, Winn HR (1998) Balloon angioplasty for the treatment of vasospasm: results of first 50 cases. Neurosurgery 42: 510–516.PubMedCrossRefGoogle Scholar
  45. 45.
    Rosenwasser RH, Armonda RA, Thomas JE, Benitez RP, Gannon PM, Harrop J (1999) Therapeutic modalities for the management of cerebral vasospasm: timing of endovascular options. Neurosurgery 44: 975–979.PubMedCrossRefGoogle Scholar
  46. 46.
    LE Roux PD, Newell DW, Eskridge J, Mayberg MR, Winn HR (1994) Severe symptomatic vasospasm: the role of im- mediate postoperative angioplasty. J Neurosurg 80: 224–229.PubMedCrossRefGoogle Scholar
  47. 47.
    Yamamoto Y, Smith RR, Bernanke DH (1992) Mechanism of action of balloon angioplasty in cerebral vasospasm. Neurosurgery 30: 1–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Elliott JP, Newell DW, Lam DJ, Eskridge JM, Douville CM, LE Roux PD, Lewis DH, Mayberg MR, Grady MS, Winn HR(1998) Comparison of balloon angioplasty and papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg 88: 277–284.Google Scholar
  49. 49.
    Bejjani GK, Bank WO, Olan WJ, Sekhar LN (1998) The efficacy and safety of angioplasty for cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 42: 979–986.PubMedCrossRefGoogle Scholar
  50. 50.
    Pistoia F, Horton JA, Sekhar L, Horowitz M (1991) Imaging of blood flow changes following angioplasty for treat ment of vasospasm. AJNR 12: 446–448.PubMedGoogle Scholar
  51. 51.
    Megyesi JF, Findlay JM, Vollrath B, Cook DA, Chen MH (1997) In vivo angioplasty prevents the development of vasospasm in canine carotid arteries. Pharmacological and morphological analyses. Stroke 28: 1216–1224.PubMedCrossRefGoogle Scholar
  52. 52.
    Muizelaar JP, Zwienenberg M, Rudisill NA, Hecht ST (1999) The prophylactic use of transluminal balloon angioplasty in patients with Fisher Grade 3 subarachnoid hem orrhage: a pilot study. J Neurosurg 91: 51–58.PubMedCrossRefGoogle Scholar
  53. 53.
    Zubkov YN, Nikiforov BM, Shustin VA (1984) Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochirurgica 70: 65–79.PubMedCrossRefGoogle Scholar
  54. 54.
    Terada T, Nakamura Y, Yoshida N, Kuriyama T, Isozaki S, Nakai K, Itakura T, Hayashi S, Komai N (1993) Percuta neous transluminal angioplasty for the M2 portion vasospasm following SAH: development of the new microballoon and report of cases. Surg Neurol 39: 13–17.PubMedCrossRefGoogle Scholar
  55. 55.
    Terada T, Kinoshita Y, Yokote H, Tsuura M, Nakai K, Itakura T, Hyotani G, Kuriyama T, Naka Y, KIDO T (1997) The effect of endovascular therapy for cerebral arterial spasm, its limitation and pitfalls. Acta Neurochirurgica 139: 227–234.PubMedCrossRefGoogle Scholar
  56. 56.
    Katoh H, Shima K, Shimizu A, Takiguchi H, Miyazawa T, Umezawa H, Nawashiro H, Ishihara S, Kaji T, Makita K, Tsuchiya K (1999) Clinical evaluation of the effect of percuta neous transluminal angioplasty and infra-arterial papaverine infusion for the treatment of vasospasm following aneurismal subarachnoid hemorrhage. Neurol Res 21: 195–203.PubMedGoogle Scholar
  57. 57.
    Linskey ME, Horton JA, Rao GR, Yonas H (1991) Fatal rup ture of the intracranial carotid artery during transluminal angioplasty for vasospasm induced by subarachnoid hem- orrhage. Case report. J Neurosurg 74: 985–990.PubMedCrossRefGoogle Scholar
  58. 58.
    Newell DW, Eskridge JM, Mayberg MR, Grady MS, Winn HR (1989) Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage.]Neurosurg 71: 654–660.Google Scholar
  59. 59.
    Mathis JM, Denardo AJ, Thibault L, Jensen ME, Savory J, Dion JE (1994) In vitro evaluation of papaverine hydrochloride incompatibilities: a simulation of intraarterial infusion for cerebral vasospasm. AJNR 15: 1665–1670.PubMedGoogle Scholar
  60. 60.
    Clyde BL, Firlik AD, Kaufmann AM, Spearman MP, Yonas H (1996) Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage. Case report. J Neurosurg 84: 690–695.PubMedCrossRefGoogle Scholar
  61. 61.
    Clouston JE, Numaguchi Y, Zoarski GH, Aldrich EF, Simard JM, Zitnay KM (1995) Intraarterial papaverine in- fusion for cerebral vasospasm after subarachnoid hemor- rhage. AJNR 16: 27–38.PubMedGoogle Scholar
  62. 62.
    Numaguchi Y, Zoarski GH (1998) Intraarterial papaverine treatment for cerebral vasospasm: our experience and review of the literature. Neurologia Medico-Chirurgica 38: 189–195.PubMedCrossRefGoogle Scholar
  63. 63.
    Mathis JM, Jensen ME, Dion JE (1997) Technical considerations on intra-arterial papaverine hydrochloride for cerebral vasospasm. Neuroradiology 39: 90–98.PubMedCrossRefGoogle Scholar
  64. 64.
    Mathis JM, Denardo A, Jensen ME, Scott J, Dion JE (1994) Transient neurologic events associated with intraarterial papaverine infusion for subarachnoid hemorrhage-induced vasospasm. AJNR 15: 1671–1674.PubMedGoogle Scholar
  65. 65.
    Kallmes DF, McGraw JK, Evans AJ, Cloft HJ, Mathis JM, Hergenrother R, Jensen ME, Dion JE (1998) Effects of sys- temic heparinization on the thrombogenicity of hydrophilic and nonhydrophilic catheters in a swine model. Neuroradi- ology 40: 530–535.CrossRefGoogle Scholar
  66. 66.
    Mcauliffe W, Townsend M, Eskridge JM, Newell DW, Grady MS, Winn HR (1995) Intracranial pressure changes induced during papaverine infusion for treatment of vaso- spasm. J Neurosurg 83: 430–434.PubMedCrossRefGoogle Scholar
  67. 67.
    Cross DT 3rd, Moran CJ, Angtuaco EE, Milburn JM, Diringer MN, Dacey RGJ (1998) Intracranial pressure mon- itoring during intraarterial papaverine infusion for cerebral vasospasm. AJNR 19: 1319–1323.PubMedGoogle Scholar
  68. 68.
    Barr JD, Mathis JM, Horton JA (1994) Transient severe brain stem depression during intraarterial papaverine infu- sion for cerebral vasospasm. AJNR 15: 719–723.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Pearse Morris
    • 1
  1. 1.School of MedicineWake Forest UniversityWinston-SalemUSA

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