Co-adjuvant Treatment of Vasospasm in Ruptured Unsecured Cerebral Aneurysms with Aggressive Angioplasty, Intra-arterial Nimodipine, and Aneurysm Embolization.

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Co-adjuvant Treatment of Vasospasm in Ruptured Unsecured Cerebral Aneurysms with Aggressive Angioplasty, Intra-arterial Nimodipine, and Aneurysm Embolization.

World Neurosurg. 2018 May 10;:

Authors: Chen CC, Yi-Chou Wang A, Chen CT, Hsieh PC

Abstract
BACKGROUND: Vasospasm is a major cause of morbidity and mortality in patients following aneurysmal subarachnoid hemorrhage (SAH). Although early treatment of ruptured aneurysms is advocated, delayed intervention complicates the treatment strategy and leading to significant vasospasm and a poor prognosis. We report our experience of endovascular protocol for occlusion of the unsecured aneurysm and angioplasty for vasospasm in a single session.
METHODS: A total of 24 cases with significant vasospasm and unsecured ruptured cerebral aneurysm were reviewed among 660 aneurysmal SAH patients between January 2011 and May 2017. Continuous nimodipine dripping through pressure line of guiding catheter was set up. Aggressive angioplasty with compliant balloon catheter either before or after embolization of the aneurysm in the major branches of vasospastic territory was performed. The aneurysm was treated with the goal of complete embolization.
RESULTS: Among the 24 patients, 17 of the 24 patients had ischemic symptoms at presentation and the average delay from aneurysm rupture to presentation was 7.58 days. Angioplasty and nimodipine dripping were performed on all patients. Severity of vasospasm was significantly reduced and outcome improved in each patient. However, two patients required a second angioplasty. In 20 patients, the aneurysms were embolized without any aneurysmal sac or residual neck. The clinical outcome was good recovery (modified Rankin scale of 0-2) in 23 cases (95.8%) and moderate disability in one patient (modified Rankin scale of 3).
CONCLUSION: Aggressive endovascular treatment of patients with unsecured ruptured cerebral aneurysm and associated vasospasm is a safe and effective therapeutic option.

PMID: 29753899 [PubMed - as supplied by publisher]

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