Endovascular therapy of cerebral vasospasm: two year experience with angioplasty and/or intraarterial administration of nicardipine and verapamil

Abstract

The cause of severe clinical vasospasm after aneurysmal subarachnoid haemorrhage remains by large a mystery, despite tremendous scientific efforts over the past three decades. However, transluminal balloon angioplasty and the intraarterial administration of vasodilatating agents represent successful tools in treating severe refractory cerebral vasospasm. Out of 350 patients admitted with acute SAH to our Medical Center over the past 2 years, 47 patients developed severe clinical vasospasm, requiring endovascular therapy. A total of 175 intraarterial nicardipine or verapamil injections were performed, while balloon angioplasty was performed in 49 vessels. There was significant (p<0.001, paired t-test) improvement of cerebral vasospasm after the intraarterial infusion of high dose verapamil or nicardipine over a period of 24–48 h. However, the administration of a vasodilatating agent followed by angioplasty represents a safe and long lasting therapy of severe clinical significant vasospasm (p<0.001, paired t-test). With current advances in endovascular technologies, balloon angioplasty along with administration of vasodilatating agents is safe and reduces the morbidity and mortality after subarachnoid haemorrhage.