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(Stroke. 2001;32:1994.)
© 2001 American Heart Association, Inc.

Original Contributions

Safety of Hemodynamic Augmentation in Patients Treated With Guglielmi Detachable Coils After Acute Aneurysmal Subarachnoid Hemorrhage

Venkatesh Aiyagari, DM; DeWitte T. Cross III, MD; Ellen Deibert, MD; Ralph G. Dacey Jr, MD Michael N. Diringer, MD

From the Neurology/Neurosurgery Intensive Care Unit, Departments of Neurology and Neurological Surgery (V.A., E.D., M.N.D.), Radiology (D.T.C.), and Neurological Surgery (R.G.D.), Washington University School of Medicine, St Louis, Mo.

Correspondence to Venkatesh Aiyagari, DM, Campus Box 8111, Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110. E-mail aiyagariv{at}neuro.wustl.edu

Background and Purpose—— Guglielmi detachable coils (GDC) used in the treatment of intracranial aneurysms do not always completely occlude the aneurysm. Thus, after an acute subarachnoid hemorrhage (SAH), there is a theoretical risk of rebleeding from coiled aneurysms, especially when blood pressure is elevated. The aim of this study is to determine whether use of hemodynamic augmentation (HA) to treat delayed ischemic deficits (DID) will increase the risk of rebleeding in these patients.

Methods—— Delayed ischemic deficits developed in 12 (7 women and 5 men, aged 31 to 64 years) of 51 patients treated with GDC for acute SAH over a 4-year period. Aneurysms in all 12 patients were 80% obliterated with GDC, and there was 90% obliteration of 78% of the aneurysms. Hemodynamic augmentation with fluids, phenylephrine, dopamine, and/or dobutamine was used to treat DID for a mean duration of 3 days (range 1 to 11 days).

Results—— With HA, mean arterial blood pressure (MAP) rose 15% (range 0 to 30%) and systolic blood pressure (SBP) rose 13% (range 0 to 29%) above baseline. MAP was maintained at >10% above baseline for 65% of the treatment period. The maximum MAP was 104 to 170 mm Hg (mean 140 mm Hg), and maximum SBP was 154 to 261 mm Hg (mean 210 mm Hg). No patient had rebleeding or any significant complication during the course of therapy.

Conclusions—— Based on this limited series of patients, we believe that it may be safe to use HA in patients treated with GDC for SAH.

Key Words: radiology, interventional • subarachnoid hemorrhage • vasospasm, intracranial

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