Endovascular Treatment of Vasospasm Related to Acute Subarachnoid Hemorrhage from Ruptured Aneurysms

Abstract

In the first 2 weeks after subarachnoid hemorrhage caused by a ruptured aneurysm, 30-35 % of surviving patients treated with conservative nonoperative therapy experience rebleeding. This is fatal in 60-90 % of cases and leads to significant disability in 17-20 % of cases. A major factor for this poor outcome is thought to be the vasospasm that occurs in up to 38.7 % by the third day, 46.3 % by the ninth day, and eventually in up to 70 % of patients. Endovascular treatment of aneurysms associated with acute subarachnoid hemorrhage has the potential to decrease the occurrence of rebleeding and therefore decrease the high mortality and morbidity associated with this disease. Treatment of vasospasm, if it does occur, has the potential to further improve patient outcomes. We describe the outcomes of 174 of our patients with acute subarachnoid hemorrhage caused by a ruptured aneurysm who were treated with endovascular techniques. Overall, the majority of our patients experienced a good or excellent outcome.

Acute care for the three leading causes of mortality in lower-middle-income countries: A systematic review

“…The use of endovascular techniques in subarachnoid hemorrhage resulted in 85% of patients without significant disability, and <2% had a procedure related fatality. [ 46 ] Although no control group was used, this case series demonstrates good results from endovascular techniques. There were no primary studies found meeting the study criteria discussing endovascular techniques like thrombectomy in LMIC.…”

Perioperative Management of Subarachnoid Hemorrhage in a Patient with Alagille Syndrome and Unrepaired Tetralogy of Fallot: Case Report

“…Cerebral vasospasm frequently appears between the third and ninth days after an SAH episode ( 13 , 14 ). The underlying pathophysiological mechanisms of vasospasm and rebleeding may include increased intracranial pressure, cerebral herniation, development of acute occlusive hydrocephalus, and stroke ( 15 , 16 ). In our patient, preoperative head CT reported hydrocephalus, although neither aneurysmal rebleeding nor vasospasm occurred during her hospital stay.…”