Therapeutic modalities for the management of cerebral vasospasm: timing of endovascular options.

Abstract:

OBJECTIVES:To determine if a window of time could be defined during which angioplasty would be most effective in reversing neurological decline and ultimately improving outcome. METHODS:Of a group of 466 patients, 93 underwent endovascular management of clinical vasospasm that was medically refractory. Eighty-four of the 93 patients were available for follow-up for at least 6 months. All patients underwent mechanical angioplasty using compliant microballoon systems and, if distal spasm was present, the administration of papaverine. RESULTS:Fifty-one patients underwent endovascular management within a 2-hour window, and 33 patients underwent treatment more than 2 hours after the development of their symptoms. Compared with the group treated more than 2 hours after neurological decline (P < 0.01; chi2 = 8.02), the group that underwent endovascular management within a 2-hour window after the development of symptoms demonstrated sustained clinical improvement. CONCLUSION:When a patient develops symptomatic vasospasm and is unresponsive to traditional measures of critical care management, angioplasty may be effective in improving the patient's neurological status if this procedure is performed as early as possible. The results indicate that a 2-hour window may exist for restoration of blood flow to ultimately improve the patient's outcome.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Rosenwasser RH,Armonda RA,Thomas JE,Benitez RP,Gannon PM,Harrop J

doi

10.1097/00006123-199905000-00022

keywords:

subject

Has Abstract

pub_date

1999-05-01 00:00:00

pages

975-9; discussion 979-80

issue

5

eissn

0148-396X

issn

1524-4040

journal_volume

44

pub_type

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