Objective To evaluate the safety and efficacy of chemical and mechanical angioplasty in the treatment of medically refractory cerebral vasospasm toward the goal of identifying factors predicting clinical outcome.
Methods All patients undergoing endovascular management of medically refractory cerebral vasospasm at the University of Michigan between 1997 and 2005 were included. Clinical and angiographic data were collected retrospectively with the review of clinical charts as well radiographic images once institutional review board approval was gained.
Results 28 patients underwent mechanical/chemical angioplasty during this time period. Demographic data included: mean age 51.8 years, 21% male, 79% female, and 89% Caucasians. Anterior circulation aneurysm comprised 52% of this patient population and 80% of the patients presented with a Hunt Hess III/IV grade SAH while 96% had a Fisher IV bleeding pattern. The mean aneurismal neck size was 3.7 mm while the dome size was 7.4 mm. 59% of the patient population had undergone microsurgery for aneurismal protection as opposed to endovascular treatment. 56% of the patients were tobacco users and 39% had a history of hypertension. 78% of the patients had presented 5–12 days post SAH. There were no vessel dissections, ruptures, or thrombosis associated with the mechanical procedure. Only 38% of patients required angioplasty involving the posterior circulation vasculature. Modified Rankin score improved from the time of vasospasm to the time of discharge with statistical significance (14% independent at time of symptoms as opposed to 53% independent at time of discharge).
Conclusion SAH associated cerebral vasospasm leads to significant morbidity and mortality. Mechanical and chemical angioplasty are safe and effective methods of preventing DIND associated with medically refractory cerebral vasospasm.
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