Korean J Radiol.  2015 Feb;16(1):180-187. 10.3348/kjr.2015.16.1.180.

Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

• Cho YD
• Han MH
• Ahn JH
• Jung SC
• Kim CH
• Kang HS
• Kim JE
• Lim JW

• KMID: 2069998
• DOI: http://doi.org/10.3348/kjr.2015.16.1.180

Abstract

OBJECTIVE
The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm.
MATERIALS AND METHODS
A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization.
RESULTS
This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions.
CONCLUSION
Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

Keyword

Aneurysm; Vasospasm; Coil embolization; Angioplasty

MeSH Terms

Adult
Aged
Aneurysm, Ruptured/*therapy
Carotid Artery, Internal/radiography
Embolization, Therapeutic
*Endovascular Procedures
Female
Humans
Intracranial Aneurysm/*therapy
Magnetic Resonance Angiography
Male
Middle Aged
Nimodipine/therapeutic use
Retrospective Studies
Vasodilator Agents/therapeutic use
Vasospasm, Intracranial/*therapy
Nimodipine
Vasodilator Agents

Figure

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  Fig. 1 Guiding catheter hub system for simultaneous management of ruptured aneurysm and vasospasm.

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  Fig. 2 Ruptured posterior communicating artery (PcomA) aneurysm.Conventional angiography of ruptured PcomA aneurysm (A), diffuse vasospasm (B), completion angiography after simultaneous treatment (aneurysm coiling and 3-mg nimodipine infusion), showing near-total occlusion of aneurysm by coils (C), and improvement in vasospasm (D).

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  Fig. 3 Ruptured anterior communicating artery (AcomA) aneurysm.Cerebral angiography of ruptured AcomA aneurysm (A), severe vasospasm, precluding passage of microcatheter for delivery of coil (B), follow-up angiography after intra-arterial infusion of nimodipine (1 mg), showing slightly dilated proximal anterior cerebral artery (in A1 segment) (C), final angiography after simultaneous treatment (aneurysm coiling and 3-mg nimodipine infusion), showing occluded aneurysm (D), and improvement in vasospasm (E).

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