A practical approach to the treatment of vasospasm.

Abstract

Subarachnoid hemorrhage from a ruptured aneurysm remains a devastating disease (1–8). In as many as one third of survivors, symptomatic vasospasm poses a significant clinical problem that can result in aphasia, hemiparesis, coma, and even death (4, 6, 9). Over the past decade, progress has been made in the treatment of vasospasm through the use of endovascular techniques. Percutaneous transluminal balloon angioplasty and intraarterial papaverine infusion have been effective in some patients (10–19). The clinical effectiveness of angioplasty has been noted in several published series (10, 11, 13, 15). It can restore neurologic function impaired by vasospasm. A report of patients presenting with proved symptomatic vasospasm and an unclipped but ruptured aneurysm described that urgent surgical obliteration of the aneurysm followed by immediate postoperative angioplasty improved outcome in 80% (20). Other studies in several patients with clipped aneurysms and significant vasospasm recommend early and aggressive angioplasty (12, 21). Despite these reports, timely angioplasty is an underused technique, perhaps in part because of the reluctance of many neuroradiologists to offer and perform angioplasty for vasospasm. This paper describes our approach to the endovascular treatment of vasospasm. The specific nature of the description is not meant to imply that it is the only safe and reasonable approach. Rather, it is intended to provide practical and detailed information to those who want to perform these procedures.