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 Akira Kurata
A1 Sachio Suzuki
A1 Kazuhisa Iwamoto
A1 Madoka Inukai
A1 Kuniaki Nakahara
A1 Kimitoshi Satou
A1 June Niki
A1 Makoto Sasaki
A1 Kiyotaka Fujii
A1 Shiichi Kan
A1 Takao Kitahara
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.