gms | German Medical Science

Objective: Cerebral vasospasms is one of the main causes of morbidity and mortality after aneurysmal subarachnoid haemorrhage (SAH). Detection in comatose patients is difficult and requires multimodal monitoring. The aim of the therapy is the improvement of the cerebral blood flow in order to prevent delayed cerebral ischemia, whereby there are little evidence-based therapy approaches. With recent improvements in endovascular techniques many positive case studies of interventional vasospasm therapy are reported in literature.

Methods: Transluminal balloon angioplasty for large vessels and intra-arterial nimodipine or papaverine infusion for small vessel vasospasm are complimentary approaches to interventional treatment of cerebral vasospasm. We report about our initial experience with endovascular vasospasm therapy in eight patients treated in last three years.

Results: 7 female and 1 male patients (average age 46) were treated with this method for refractory vasospasm after aneurysmal SAH between 2013 and 2016. Aneurysms closure was microsurgical in 2 and endovascular in 6 cases. The number of endovascular interventions for vasospasm was between 2 and 6. The outcome in mRs was 0 in 3 cases, 3 in 2 cases, 5 in 2 cases and 6 in 1 case.

Conclusion: The endovascular treatment with balloon angioplasty and/or selective intra-arterial vasodilator therapy should be considered as valuable therapy option in patients with symptomatic cerebral vasospasm who are not responding to conservative treatment but it is logistically sophisticated and time-consuming therapy. Prospective randomized trials with larger case numbers are desirable.