Coadjuvant Treatment of Vasospasm in Ruptured Unsecured Cerebral Aneurysms with Aggressive Angioplasty, Intra-Arterial Nimodipine, and Aneurysm Embolization

World Neurosurgery
Ching-Chang ChenPo-Chuan Hsieh

Abstract

Vasospasm is a major cause of morbidity and mortality in patients after aneurysmal subarachnoid hemorrhage. Early treatment of ruptured aneurysms is advocated; delayed intervention complicates the treatment strategy leading to significant vasospasm and poor prognosis. We report an endovascular protocol for occlusion of the unsecured aneurysm and angioplasty for vasospasm in a single session. Between January 2011 and May 2017, among 660 patients with aneurysmal subarachnoid hemorrhage, 24 patients with significant vasospasm and unsecured ruptured cerebral aneurysm were reviewed. Continuous nimodipine drip through a pressure line of the guiding catheter was set up. Aggressive angioplasty with a compliant balloon catheter either before or after embolization of the aneurysm in the major branches of vasospastic territory was performed. The goal was complete embolization of the aneurysm. Of 24 patients, 17 had ischemic symptoms at presentation, and the average delay from aneurysm rupture to presentation was 7.58 days. Angioplasty and nimodipine drip were performed on all patients. Severity of vasospasm was significantly reduced, and outcome improved in each patient. Two patients required a second angioplasty. In 20 patients, emboliza...Continue Reading

References

Oct 13, 2011·Journal of Neurointerventional Surgery·Akira KurataTakao Kitahara
Jan 31, 2013·Journal of Neurointerventional Surgery·Joseph SerroneAndrew J Ringer
Jan 20, 2015·Korean Journal of Radiology : Official Journal of the Korean Radiological Society·Young Dae ChoJeong Wook Lim
Nov 4, 2016·Journal of Neurointerventional Surgery·Doniel DrazinDileep R Yavagal

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Citations

Jan 8, 2021·World Neurosurgery·Ching-Chang ChenAlvin Yi-Chou Wang
Jul 6, 2021·World Neurosurgery·Victoria E SanchezJeremiah N Johnson

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