NS02 UPDATE ON CEREBRAL VASOSPASM

Abstract

Purpose To review the incidence of vasospasm after cerebral aneurysm rupture, and compare the results with a previous review.Methodology An online search of articles from 2001 to 2006 with “cerebral vasospasm” as key words.Results From 75 studies involving 10717 SAH patients, delayed ischaemia was reported in 3257, or 30.4%. In a previous review of 32188 reported cases up to the early 1990s, the incidence was 32.5% (1). Those data excluded patients treated with calcium antagonists, which on the other hand were used in at least 3600 of the present 10717.Therapeutic possibilities include endothelin antagonists. In a trial of clazosentan the incidence of angiographic vasospasm was reduced, but outcome was unchanged. A controlled trial of MgSO4 showed delayed cerebral ischaemia in 24% of controls and 17% treated, and a 23% risk reduction for poor outcome. In two studies of statins there was significantly less DID in treated groups, and a 75% reduction in death rate with pravastatin treatment. Results of these and other trials, including implantation of slow‐release pellets, lamina terminalis fenestration and variations of CSF drainage, will be presented in detail.Conclusions Promising therapeutic options for vasospasm are under study, but there is still no universally effective treatment. The incidence of delayed ischaemia has not changed much over the decades, but the clinical impression is that the problem of vasospasm is less now than 20 to 30 years ago. This may be due to improved fluid management – patients are usually treated with at least mild hypervolaemia rather than the considerable dehydration that was the norm in the 1960s and 70s.