Multicenter Evaluation of the Efficacy of Endovascular Treatment for Symptomatic Vasospasm unresponsive to Hypervolemic and Hypertensive Therapy in Patients with Subarachnoid Hemorrhage.
BACKGROUND AND PURPOSE: Symptomatic vasospasm remains an important cause of morbidity and mortality in patients with subarachnoid hemorrhage (SAH). Endovascular techniques have recently been introduced for treatment of vasospasm resistant to medical treatment. We performed this study to determine the safety and efficacy of these techniques in a large series of patients with SAH. METHODS:We reviewed the medical records, angiograms, and computed tomographic (CT) scans for patients who underwent endovascular treatment for symptomatic vasospasm at 3 university-affiliated centers. The following outcomes were analyzed; angiographic improvement, neurological improvement, ability to prevent cerebral infarction as demonstrated by serial CT scans, and outcome at 3 months using Glasgow Outcome Scale (GOS). RESULTS:Forty-five patients (mean age 51 ±10 years; 13 were men) were treated for symptomatic vasospasm. The vasospasm was graded as severe (n=27), moderate (n=16), and mild (n=2) by angiographic criteria. Angioplasty was performed in 26 patients; intra-arterial papaverine was administered as adjunctive therapy in 11 procedures. Nineteen patients were treated with intra-arterial papaverine alone. Angiographic improvement was documented in all patients. Cerebral infarction was observed in 29 (64%) of 45 patients on follow-up CT scan. Good outcome (minimal or no disability by GOS) was seen in 12 (27%) patients. CONCLUSIONS:Although endovascular treatment of symptomatic vasospasm results in good angiographic response, a high proportion of cerebral infarction and poor outcomes is still observed in patients who failed medical treatment. New strategies need to be developed to improve outcome in this subset of patients with SAH.