Endovascular management of cerebral vasospasm following aneurysm rupture: Outcomes and predictors in 116 patients

Nohra Chalouhi, Stavropoula Tjoumakaris, Vismay Thakkar, Thana Theofanis, Christine Hammer, David Hasan, Robert M. Starke, Chengyuan Wu, L. Fernando Gonzalez, Robert Rosenwasser, Pascal Jabbour

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

Objective To retrospectively assess the safety and efficacy of endovascular treatment of cerebral vasospasm with different modalities and assess predictors of outcome. Methods Endovascular treatment was indicated in the event of neurological deterioration refractory to medical therapy. Data were collected for 116 patients treated at our institution. Results Vasospasm was treated with balloon angioplasty in 52.6%, intra-arterial nicardipine infusion in 19.8%, or both in 27.6%. Angiographic vasospasm was reversed in all but 4 (96.6%) patients. The complication rate was 0.9%. Twenty patients (17.2%) had incipient pre-procedure hypodensities; 3 (15%) hypodensities were reversed and neurological improvement occurred in 60% of these patients. Retreatment was required in 22 (19%) patients. Higher Hunt and Hess grades and treatment with nicardipine alone predicted retreatment. Neurological improvement was noted in 82%. Male gender, pre-procedure hypodensities, and posterior communicating artery aneurysm location negatively predicted neurological recovery. Favorable outcomes were noted in 73%. Higher Hunt and Hess grades, pre-procedure hypodensities, posterior circulation aneurysms, and no neurological recovery predicted poor outcome. Conclusion Endovascular therapy for vasospasm has an excellent safety-efficacy profile. Balloon angioplasty and nicardipine are equally effective but effects of nicardipine are less durable. Patients with incipient pre-procedure hypodensities benefit from endovascular intervention and should probably not be excluded from treatment.

Original languageEnglish (US)
Pages (from-to)26-31
Number of pages6
JournalClinical Neurology and Neurosurgery
Volume118
DOIs
StatePublished - Mar 2014
Externally publishedYes

Keywords

  • Aneurysm
  • Balloon angioplasty
  • Nicardipine
  • Vasospasm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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