Document Detail


Endovascular management of posthemorrhagic cerebral vasospasm: indications, technical nuances, and results.
MedLine Citation:
PMID:  22890655     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Posthemorrhagic cerebral vasospasm (PHCV) is a common problem and a significant cause of mortality and permanent disability following aneurysmal subarachnoid hemorrhage. While medical therapy remains the mainstay of prevention against PHCV and the first-line treatment for symptomatic patients, endovascular options should not be delayed in medically refractory cases. Although both transluminal balloon angioplasty (TBA) and intra-arterial vasodilator therapy (IAVT) can be effective in relieving proximal symptomatic PHCV, only IAVT is a viable treatment option for distal vasospasm. The main advantage of TBA is its long-lasting therapeutic effect and the very low rate of retreatment. However, its use has been associated with a significant risk of serious complications, particularly vessel rupture and reperfusion hemorrhage. Conversely, IAVT is generally considered an effective and low-risk procedure, despite the transient nature of its therapeutic effects and the risk of intracranial hypertension associated with its use. Moreover, newer vasodilator agents appear to have a longer duration of action and a much better safety profile than papaverine, which is rarely used in current clinical practice. Although endovascular treatment of PHCV has been reported to be effective in clinical series, whether it ultimately improves patient outcomes has yet to be demonstrated in a randomized controlled trial.
Authors:
Ralph Rahme; Lincoln Jimenez; Gail J Pyne-Geithman; Joseph Serrone; Andrew J Ringer; Mario Zuccarello; Todd A Abruzzo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta neurochirurgica. Supplement     Volume:  115     ISSN:  0065-1419     ISO Abbreviation:  Acta Neurochir. Suppl.     Publication Date:  2013  
Date Detail:
Created Date:  2012-08-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100962752     Medline TA:  Acta Neurochir Suppl     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  107-12     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, University of Cincinnati and Mayfield Clinic, Cincinnati, OH, USA.
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