RT Journal Article
SR Electronic
T1 Efficacy of endovascular surgery for ruptured aneurysms with vasospasm of the parent artery
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 190
OP 195
DO 10.1136/neurintsurg-2011-010007
VO 4
IS 3
A1 Kurata, Akira
A1 Suzuki, Sachio
A1 Iwamoto, Kazuhisa
A1 Inukai, Madoka
A1 Nakahara, Kuniaki
A1 Satou, Kimitoshi
A1 Niki, June
A1 Sasaki, Makoto
A1 Fujii, Kiyotaka
A1 Kan, Shiichi
A1 Kitahara, Takao
YR 2012
UL http://jnis.bmj.com/content/4/3/190.abstract
AB Introduction In the presence of vasospasm it is recommended that surgical clipping for a ruptured aneurysm should be delayed until it disappears, but this may be associated with re-rupture of the aneurysm resulting in a poor outcome. The indications for endovascular coil embolization in such cases are discussed.Methods Since November 2002, endovascular coil embolization has been used in 18 consecutive patients with ruptured aneurysm with vasospasm of the parent artery ranging from 2 to 28 days (mean 9 days) after the initial subarachnoid hemorrhage. After successful obliteration of the aneurysm, a microcatheter preceded by a guidewire was introduced into the peripheral vessels with vasospasm of the A2 or M2 portions in order to release the vasospasm mechanically.Results Endovascular procedures were performed successfully in all but one of the cases (94%), resulting in complete occlusion in 14 of 17 patients and mild dilation of the vasospasm in all 17 patients without technical complications or re-rupture of the aneurysm. In the one case of failure because of a tortuous artery, surgical clipping was performed after disappearance of the vasospasm. Cerebral infarction occurred in four patients, but only one correlated with the distribution of catheterization and the neurological deficits had completely disappeared 3 months after the onset.Conclusion Catheterization of parent vessels in cases of vasospasm is safe for coiling and also mechanically releases vasospasm. Vasospasm of M2 and A2 segments can be treated with microcatheterization only.