Endovascular Treatment of Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Kim, Jong Soo; Byun, Hong Sik; Lee, Jung Il; Hong, Seung Chyul; Shin, Hyung Jin; Park, Kwan; Eoh, Whan; Kim, Jong Hyun

Abstract

The delayed vasospasm after aneurysmal subarachnoid hemorrhage is the main cause of morbidity and mortality in the treatment of intracranial aneurysm. Of 158 cases of ruptured intracranial aneurysm treated with radical surgery from October 1994 to December 1996, there were 29 cases of symptomatic vasospasm. Of these 12 cases were treated by intraarterial papaverine injection and/or transluminal balloon angioplasty. Refractoriness to conservative medical therapy was the main indicaiton for the endovascular treatment. Intraarterial papaverine injection was done in 11 cases and balloon angioplasty in 8 cases. After endovascular treatment, angiographic improvement was achieved in 9 cases(75%). Clinical improvement within 24 hours after treatment was observed in 8 cases(66.7%). There were two cases of complication; rupture of MCA and thromboembolism of distal branch. Outcome at the time of discharge were good recovery in 8 cases, moderate disability in 2, and death in 2. It is suggested that the endovascular method can be considered to be effective and powerful tool for the treatment of symptomatic vasospasm after aneurysmal SAH. But the complications related with this should be borne in mind. Exact indication and proper timing of endovascular treatment are to be further studied.