Traitement pharmacologique du vasospasme de l'hémorragie sous-arachnoïdienne

Abstract

Pharmacological treatment of vasospasm in subarachnoid haemorrhage (SAH) is founded on prevention and treatment of arterial narrowing and delayed ischaemic deficits. Safety and efficacy of different agents have been studied and trials classified according to the level of evidence proposed by the “Stroke Council” of the American Heart Association. Early intracisternal fibrinolysis can prevent vasospasm (level III to V of evidence, grade C). Pharmacological treatment is based on few drugs. Nimodipine reduces poor outcome related to vasospasm, but does not affect angiographic vessel caliber (level of evidence I and II, grade A). Its use is strongly recommended. Nicardipine decreases symptomatic and angiographic vasospasm, but does not affect outcome (level of evidence I to V, grade B). Tirilazad associated with nimodipine prevents delayed ischaemic deficits due to vasospasm and improves outcome in male patients. Intra-arterial infusion of papaverine associated with transluminal angioplasty can improve symptomatic vasospasm, resistant to conventional therapy (level of evidence IV to V, grade C). Pharmacological treatment of vasospasm associated with specific management founded on pathophysiology of SAH has improved patients outcome.