Therapeutic Modalities for the Management of Cerebral Vasospasm: Timing of Endovascular Options

Rosenwasser, Robert H.; Armonda, Rocco A.; Thomas, Jeffrey E.; Benitez, Ronald P.; Gannon, Patricia; Harrop, James

doi:10.1097/00006123-199905000-00022

Cited by 210 publications

(111 citation statements)

References 26 publications

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“…Éste puede evaluarse indirectamente por la mejoría clínica o directamente mediante estudios de flujo sanguíneo cerebral antes y después del tratamiento. A pesar de que se han publicado excelentes resultados angiográficos de la ATP (mejoría angiográfica cercana al 100%) 18,19 , sus resultados clínicos son variables y las tasas de mejoría neurológica oscilan entre el 31 y el 93% tras el tratamiento [20][21][22] . En una extensa revisión de la literatura, Hoh et al 21 estimaron que el 62% de los pacientes mejoraron de su déficit neurológico tras la angioplastia.…”

Section: Eficacia Clínica Y Resultadosunclassified

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

Alcázar

González

Romance³

2008

Medicina Intensiva

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El vasospasmo cerebral es una de las principales causas de morbimortalidad en los pacientes con hemorragia subaracnoidea por rotura de un aneurisma cerebral. Cuando el vasospasmo se hace resistente al tratamiento médico máximo, el tratamiento endovascular es una opción terapéu-tica para incrementar el flujo sanguíneo cerebral y evitar lesiones isquémicas cerebrales. Los rápi-dos avances en técnicas endovasculares permiten utilizar la angioplastia transluminal percutá-nea y la infusión intraarterial de diversos fármacos vasodilatadores para revertir el vasospasmo. En este artículo se revisan las diferentes técnicas endovasculares disponibles y se describen sus mecanismos de acción, técnicas de administración, resultados clínicos y complicaciones. ENDOVASCULAR TREATMENT OF CEREBRAL VASOSPASM DUE TO ANEURYSMAL SUBARACHNOID HEMORRHAGECerebral vasospasm remains a leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage. When vasospasm becomes refractory to maximal medical treatment, endovascular therapies may be considered as an option to increase cerebral blood flow to prevent cerebral infarction. Endovascular techniques include transluminal balloon angioplasty and intraarterial infusion of vasorelaxants.This article reviews the various endovascular techniques for the treatment of cerebral vasospasm and discusses the mechanisms of action, techniques of administration, clinical results, and limitations of these treatment strategies.

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Section: Eficacia Clínica Y Resultadosunclassified

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

Alcázar

González

Romance³

2008

Medicina Intensiva

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“…Twenty-eight (61%) of their 46 patients with clinical vasospasm who underwent treatment within 18 hours after onset of symtpoms showed sustained clinical improvement (according to the GCS) after 72 hours posttreatment, which was also demonstrated on TCD and angiography studies. In their study of 80 patients treated with TBA for neurological deterioration due to cerebral vasospasm, Rosenwasser and colleagues [17] were able to demonstrate clinical improvement in 70% and angiographic improvement in 90% of patients when they were treated within a lag time of 2 hours after onset of symptoms. Bejjani, et al, [1] retrospectively studied the outcome of 31 patients after undergoing TBA, and 72% improved within 24 to 36 hours after angioplasty.…”

Section: Neurological Improvement After Tbamentioning

confidence: 97%

“…[1,13,17,19] Zubkov, et al, [19] advocated endovascular treatment for vasospasm even before the onset of clinical symptoms. In their series 95 consecutive patients were treated for angiographic and clinical vasospasm with balloon angioplasty, and the policy in their protocol was to treat every patient with vasospasm with or without symptoms.…”

Section: Timing Of Endovascular Treatment Modalitiesmentioning

confidence: 99%

“…[1][2][3][4][5][6][8][9][10][11]13,[14][15][16][17]18,19,21] However, many of the early reports on the benefits of the treatments are anecdotal, and most studies were uncontrolled, involved numbers of patients that were too small to show more than a trend of beneficial effects, or used ambiguous scales to determine clinical improvement in patients after treatment.…”

mentioning

confidence: 99%

“…[1,13,17,19] Recommendations range from treatment of vasospasm that presents only angiographically with no clinical symptoms [19] to a lag time as long as 24 hours after the clinical deterioration. [1] In reviewing the literature, we find no consensus on treatment timing.…”

mentioning

confidence: 99%

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Endovascular treatment for symptomatic cerebral vasospasm after subarachnoid hemorrhage: transluminal balloon angioplasty compared with intraarterial papaverine

Coenen¹,

Hansen²,

Mstat³

et al. 1998

FOC

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The authors retrospectively evaluated the short-term neurological improvement of 69 patients undergoing endovascular treatment for symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). The patient group observed here is a subset of patients enrolled in the multicenter North American Trial of Tirilazad in SAH. Thirty-one patients were treated with intraarterial administration of papaverine (IAP). Fourteen patients were only treated with transluminal balloon angioplasty (TBA), and 24 patients received a combination of angioplasty and papaverine. The purpose of this study was to compare the effects of IAP and TBA on short-term clinical improvement of patients. Daily clinical staging with the modified Glasgow Coma Scale and every-other-day transcranial Doppler (TCD) measurements allowed for a close investigation of the clinical course. Furthermore, this study was designed to investigate the effects of treatment timing on short-term outcome. Although TCD studies demonstrated a decrease in flow velocities in the middle cerebral artery in both treatment groups, indicating a vasodilating effect of both treatment modalities (dv = -18.4 cm/second for papaverine, dv = -26.04 cm/second for angioplasty; p = 0.5509), there was no significant difference in clinical improvement at Days 1 and 4 postprocedure (p = 0.1996). Neither of the two treatment forms showed an effect of therapy timing on neurological outcome. Neither IAP nor TBA was correlated with a high percentage of short-term neurological improvement. The authors discuss reasons why those procedures may result in limited clinical change.

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Endovascular treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage

Schuknecht

Acta Neurochirurgica Supplements

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Therapeutic Modalities for the Management of Cerebral Vasospasm: Timing of Endovascular Options

Cited by 210 publications

References 26 publications

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

Tratamiento endovascular del vasospasmo cerebral inducido por hemorragia subaracnoidea aneurismática

Endovascular treatment for symptomatic cerebral vasospasm after subarachnoid hemorrhage: transluminal balloon angioplasty compared with intraarterial papaverine

Endovascular treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage

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