Invasive interventional management of post-hemorrhagic cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage
- Todd Abruzzo1,
- Christopher Moran2,
- Kristine A Blackham3,
- Clifford J Eskey4,
- Raisa Lev5,
- Philip Meyers6,
- Sandra Narayanan7,
- Charles Joseph Prestigiacomo8
- 1Department of Neurosurgery, University of Cincinnati and Mayfield Clinic, Cincinnati, USA
- 2Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, Missouri, USA
- 3University Hospitals Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
- 4Department of Radiology, Neurology and Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- 5Department of Radiology, Aurora Baycare Medical Center, Green Bay, Michigan, USA
- 6Department of Neurosurgery, Columbia University, New York, New York, USA
- 7Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA
- 8Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
- Correspondence to Dr T Abruzzo, Neurosurgery, University of Cincinnati and Mayfield Clinic, Cincinnati, USA;
Contributors All stated authors contributed to the work submitted.
- Received 26 December 2011
- Accepted 28 December 2011
- Published Online First 28 February 2012
Current clinical practice standards are addressed for the invasive interventional management of post-hemorrhagic cerebral vasospasm (PHCV) in patients with aneurysmal subarachnoid hemorrhage. The conclusions, based on an assessment by the Standards Committee of the Society of Neurointerventional Surgery, included a critical review of the literature using guidelines for evidence based medicine proposed by the Stroke Council of the American Heart Association and the University of Oxford, Centre for Evidence Based Medicine. Specifically examined were the safety and efficacy of established invasive interventional therapies, including transluminal balloon angioplasty (TBA) and intra-arterial vasodilator infusion therapy (IAVT). The assessment shows that these invasive interventional therapies may be beneficial and may be considered for PHCV—that is, symptomatic with cerebral ischemia and refractory to maximal medical management. As outlined in this document, IAVT may be beneficial for the management of PHCV involving the proximal and/or distal intradural cerebral circulation. TBA may be beneficial for the management of PHCV that involves the proximal intradural cerebral circulation. The assessment shows that for the indications described above, TBA and IAVT are classified as Class IIb, Level B interventions according to the American Heart Association guidelines, and Level 4, Grade C interventions according to the University of Oxford Centre for Evidence Based Medicine guidelines.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.