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Critical Care Guidelines on the Endovascular Management of Cerebral Vasospasm

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Abstract

Cerebral vasospasm and delayed cerebral ischemia account for significant morbidity and mortality after aneurysmal subarachnoid hemorrhage. While most patients are managed with triple-H therapy, endovascular treatments have been used when triple-H treatment cannot be used or is ineffective. An electronic literature search was conducted to identify English language articles published through October 2010 that addressed endovascular management of vasospasm. A total of 49 articles were identified, addressing endovascular treatment timing, intra-arterial treatments, and balloon angioplasty. Most of the available studies investigated intra-arterial papaverine or balloon angioplasty. Both have generally been shown to successfully treat vasospasm and improve neurological condition, with no clear benefit from one treatment compared with another. There are reports of complications with both therapies including vessel rupture during angioplasty, intracranial hypertension, and possible neurotoxicity associated with papaverine. Limited data are available evaluating nicardipine or verapamil, with positive benefits reported with nicardipine and inconsistent benefits with verapamil.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Florida, 1600 South West Archer Rd, P.O. Box 100265, Gainesville, FL, 32610, USA

    Matthew M. Kimball, Gregory J. Velat & Brian L. Hoh

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  1. Matthew M. Kimball
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  2. Gregory J. Velat
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  3. Brian L. Hoh
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The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage

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Correspondence to Brian L. Hoh.

Additional information

The Participants in the International Multi-disciplinary Consensus Conference: Michael N. Diringer, Thomas P. Bleck, Nicolas Bruder, E. Sander Connolly Jr, Giuseppe Citerio, Daryl Gress, Daniel Hanggi, J. Claude Hemphill III MAS, Brian Hoh, Giuseppe Lanzino, Peter Le Roux, David Menon, Alejandro Rabinstein, Erich Schmutzhard, Lori Shutter, Nino Stocchetti, Jose Suarez, Miriam Treggiari, MY Tseng, Mervyn Vergouwen, Paul Vespa, Stephan Wolf, Gregory J. Zipfel.

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Kimball, M.M., Velat, G.J., Hoh, B.L. et al. Critical Care Guidelines on the Endovascular Management of Cerebral Vasospasm. Neurocrit Care 15, 336–341 (2011). https://doi.org/10.1007/s12028-011-9600-1

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