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KEY FACTS
Terminology
Pre-Procedure
Procedure
TERMINOLOGY
Definitions
Cerebral vasospasm:Narrowing/constriction of intracranial arteries after subarachnoid hemorrhage (SAH); caused by overcontraction of arterial wall
Also known as subarachnoid hemorrhage vasospasm
Ruptured intracerebral aneurysm dominant etiology
Vasospasm affects 60-70% patients after SAH
Symptomatic ischemia in 30%; manifested by
Altered level of consciousness/confusion
Focal neurological deficit
Death/serious disability in 1/3 of patients with SAH
Caused by exposure to blood breakdown products
Vasospastic reversible stenosis
Inflammation
Changes in arterial wall
Altered level of vasoactive substances
Onset usually after day 3 of SAH
Maximal severity 4-14 days after SAH
Significantly reduced or gone within 3 weeks
Risk factors for symptomatic vasospasm
Amount of blood on initial head CT scan
Age < 50 years
Hyperglycemia
History of hypertension
Larger aneurysm size
Intraventricular hemorrhage
Cocaine use
Endovascular options for treatment of vasospasm
Balloon angioplasty(PTA)
Mostly for large/medium (> 1.5 mm) vessel spasm
Proximal intracranial arteries amenable to PTA
Internal carotid (ICA)/vertebral/basilar arteries
M1 segment of middle cerebral artery (MCA)
A1 segment of anterior cerebral artery (ACA)
P1 segment of posterior cerebral artery (PCA)
Intraarterial pharmacologic infusion
For more distal branch vasospasm
Vessels not safely treated with angioplasty
Transcranial Doppler ultrasonography (TCD): Measurement of blood flow velocities in major branches of circle of Willis through intact skull
Noninvasive vasospasm evaluation/monitoring
2-4 MHz pulsed-wave Doppler with spectral analysis
Measurement supports grading
Vasospasm severity
Localization of intracranial stenoses/occlusions
PRE-PROCEDURE
Indications
Pre-Procedure Imaging
Getting Started
PROCEDURE
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST-PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Complications
Selected References
McGuinness B et al: Endovascular management of cerebral vasospasm. Neurosurg Clin N Am. 21(2):281-90, 2010
Pradilla G et al: Inflammation and cerebral vasospasm after subarachnoid hemorrhage. Neurosurg Clin N Am. 21(2):365-79, 2010
Schmidt U et al: Hemodynamic management and outcome of patients treated for cerebral vasospasm with intraarterial nicardipine and/or milrinone. Anesth Analg. 110(3):895-902, 2010
Webb A et al: The effect of intraventricular administration of nicardipine on mean cerebral blood flow velocity measured by transcranial Doppler in the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. Neurocrit Care. 12(2):159-64, 2010
Jabbour PM et al: Neuroendovascular management of vasospasm following aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 20(4):441-6, 2009
Kwon OY et al: The utility and benefits of external lumbar CSF drainage after endovascular coiling on aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc. 43(6):281-7, 2008
Sayama CM et al: Update on endovascular therapies for cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage. Neurosurg Focus. 21(3):E12, 2006
Hoh BL et al: Endovascular treatment of cerebral vasospasm: transluminal balloon angioplasty, intra-arterial papaverine, and intra-arterial nicardipine. Neurosurg Clin N Am. 16(3):501-16, vi, 2005
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Pre-Procedure
Procedure
TERMINOLOGY
Definitions
Cerebral vasospasm:Narrowing/constriction of intracranial arteries after subarachnoid hemorrhage (SAH); caused by overcontraction of arterial wall
Also known as subarachnoid hemorrhage vasospasm
Ruptured intracerebral aneurysm dominant etiology
Vasospasm affects 60-70% patients after SAH
Symptomatic ischemia in 30%; manifested by
Altered level of consciousness/confusion
Focal neurological deficit
Death/serious disability in 1/3 of patients with SAH
Caused by exposure to blood breakdown products
Vasospastic reversible stenosis
Inflammation
Changes in arterial wall
Altered level of vasoactive substances
Onset usually after day 3 of SAH
Maximal severity 4-14 days after SAH
Significantly reduced or gone within 3 weeks
Risk factors for symptomatic vasospasm
Amount of blood on initial head CT scan
Age < 50 years
Hyperglycemia
History of hypertension
Larger aneurysm size
Intraventricular hemorrhage
Cocaine use
Endovascular options for treatment of vasospasm
Balloon angioplasty(PTA)
Mostly for large/medium (> 1.5 mm) vessel spasm
Proximal intracranial arteries amenable to PTA
Internal carotid (ICA)/vertebral/basilar arteries
M1 segment of middle cerebral artery (MCA)
A1 segment of anterior cerebral artery (ACA)
P1 segment of posterior cerebral artery (PCA)
Intraarterial pharmacologic infusion
For more distal branch vasospasm
Vessels not safely treated with angioplasty
Transcranial Doppler ultrasonography (TCD): Measurement of blood flow velocities in major branches of circle of Willis through intact skull
Noninvasive vasospasm evaluation/monitoring
2-4 MHz pulsed-wave Doppler with spectral analysis
Measurement supports grading
Vasospasm severity
Localization of intracranial stenoses/occlusions
PRE-PROCEDURE
Indications
Pre-Procedure Imaging
Getting Started
PROCEDURE
Equipment Preparation
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST-PROCEDURE
Expected Outcome
Things to Do
Things to Avoid
OUTCOMES
Complications
Selected References
McGuinness B et al: Endovascular management of cerebral vasospasm. Neurosurg Clin N Am. 21(2):281-90, 2010
Pradilla G et al: Inflammation and cerebral vasospasm after subarachnoid hemorrhage. Neurosurg Clin N Am. 21(2):365-79, 2010
Schmidt U et al: Hemodynamic management and outcome of patients treated for cerebral vasospasm with intraarterial nicardipine and/or milrinone. Anesth Analg. 110(3):895-902, 2010
Webb A et al: The effect of intraventricular administration of nicardipine on mean cerebral blood flow velocity measured by transcranial Doppler in the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. Neurocrit Care. 12(2):159-64, 2010
Jabbour PM et al: Neuroendovascular management of vasospasm following aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am. 20(4):441-6, 2009
Kwon OY et al: The utility and benefits of external lumbar CSF drainage after endovascular coiling on aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc. 43(6):281-7, 2008
Sayama CM et al: Update on endovascular therapies for cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage. Neurosurg Focus. 21(3):E12, 2006
Hoh BL et al: Endovascular treatment of cerebral vasospasm: transluminal balloon angioplasty, intra-arterial papaverine, and intra-arterial nicardipine. Neurosurg Clin N Am. 16(3):501-16, vi, 2005
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