gms | German Medical Science

Objective: Guidelines mention intraarterial spasmolysis (iaSp) as a treatment for delayed vasospasms (VS) following subarachnoid hemorrhage (SAH). Like other procedures its benefit has not been proven by controlled randomized studies. Standard treatment for VS is elevation of perfusion pressure (PP). However, experience in daily neurosurgical practice is that despite increased PP and iaSp infarcts following VS may occur. The aim of this study is to calculate the incidence of ischemic lesions following VS and to detect predisposing factors associated with the occurrence of infarcts in a mono-center series of patients (pts.) with SAH.

Methods: Monocenter evaluation of all SAH pts. over 12 months. Documentation of the following items: aneurysma treatment (Clip:31/53 or coiling: 23/53); occurrence of VS; treatment with 1 to 4 angiographical (DSA) iaSp with nimodipine or/and angioplasty; amount of cerebral infarcts documented by CCT, clinical symptoms, course of continuous blood pressure and PP.

Results: 58 eligible pts. have been collected within 12 months, 5 of them with incident aneurysms. Indications for diagnostic procedures of 1 to 4 DSA and eventual iaSp were: development of neurological deficits (n=6) or decrease of consciousness or significant alteration of blood flow velocity in (daily performed) TCD. An infarct due to VS in CCT on day of admission was diagnosed in one pt. One or multiple ischemic lesions have been detected in 41/58 pts. within 3 weeks of acute Admission. 17 of these 41 pts. with lesions did not receive a DSA / iaSp. 24 of these 41 pts. received a DSA: in 5 of them iaSp had not been performed, in 19 of these 24 pts. iaSp had been performed and 15 of these 19 pts. with iaSp suffered from one or several ischemic lesions. Infarcts have not been detected in repeated CCT in 4 pts. undergoing DSA and iaSp.

Conclusion: In this series of 58 successively admitted pts. with SAH, ischemic lesions occurred in more than 70% (41/53 pts., excluding 5 pts. with incident aneurysms) within 21 days. In 15 out of 19 patients with singular or repeated vasospasm ischemic lesions have been observed. In all pts. with proven vasospasms and elimination of all existing aneurysms, perfusion pressure was elevated to a mean blood pressure of at least 100 mmHg. Infarcts despite spasmolysis occurred more often as predisposing factors in pts. with GCS below 8 or Fisher grade 3 or 4. In our opinion a controlled study is justified to decide about the value of this treatment.