Balloon angioplasty immediately after surgical clipping for symptomatic vasospasm on admission. Report of four cases.

Abstract:

:In spite of recent advancements in the management of ruptured aneurysm, there are still controversies as to how to threat the patients in serious conditions, one of these concerning whether to operate patients admitted with symptomatic vasospasm (vasospasm on admission) and when. While early surgery may protect patient from further rupturing, it may also increase risk of worsening by inducing much more vasospasm. Four cases of severe vasospasm associated with aneurysmal subarachnoid hemorrhage (SAH) were reported. All of these cases showed symptomatic and angiographical vasospasm on their admission 3-11 days after initial attack of SAH. All cases had a preoperative clinical grading using Hunt & Kosnik of IV, and were treated by early surgery with clipping followed by percutaneous balloon angioplasty (PTA) immediately after clipping. Two cases returned to their previous occupations, while one case remained bed ridden and one died in spite of therapy. Early surgery in this series actually prevented further rupturing, but it is not clear whether PTA immediately after clipping may prevent further deterioration by progression of vasospasm. For selected cases especially those with reversible ischemia, this combined treatment may offer more favorable results than late surgery with conservative medical care. Further investigation is necessary to support the validity of this therapy.

journal_name

Neurosurg Rev

journal_title

Neurosurgical review

authors

Fujii Y,Takahashi A,Ezura M,Mizoi K

doi

10.1007/BF00417662

subject

Has Abstract

pub_date

1995-01-01 00:00:00

pages

79-84

issue

2

eissn

0344-5607

issn

1437-2320

journal_volume

18

pub_type

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