Therapeutic Modalities for the Management of Cerebral Vasospasm: Timing of Endovascular Options

Therapeutic Modalities for the Management of Cerebral Vasospasm: Timing of Endovascular Options AbstractOBJECTIVETo determine if a window of time could be defined during which angioplasty would be most effective in reversing neurological decline and ultimately improving outcome.METHODSOf a group of 466 patients, 93 underwent endovascular management of clinical vasospasm that was medically refractory. Eighty-four of the 93 patients were available for follow-up for at least 6 months. All patients underwent mechanical angioplasty using compliant microballoon systems and, if distal spasm was present, the administration of papaverine.RESULTSFifty-one patients underwent endovascular management within a 2-hour window, and 33 patients underwent treatment more than 2 hours after the development of their symptoms. Compared with the group treated more than 2 hours after neurological decline (P < 0.01; χ2 = 8.02), the group that underwent endovascular management within a 2-hour window after the development of symptoms demonstrated sustained clinical improvement.CONCLUSIONWhen a patient develops symptomatic vasospasm and is unresponsive to traditional measures of critical care management, angioplasty may be effective in improving the patient's neurological status if this procedure is performed as early as possible. The results indicate that a 2-hour window may exist for restoration of blood flow to ultimately improve the patient's outcome. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Therapeutic Modalities for the Management of Cerebral Vasospasm: Timing of Endovascular Options

Therapeutic Modalities for the Management of Cerebral Vasospasm: Timing of Endovascular Options

Therapeutic Modalities for the Management of Cerebral Vasospasm: Timing of Endovascular Options Robert H. Rosenwasser, M .D ., Rocco A. Armonda, M .D ., Jeffrey E. Thomas, M .D ., Ronald P. Benitez, M .D ., Patricia M. Gannon, R.N., James Harrop, M .D. D e p a r t m e n t o f N e u r o s u r g e r y , D i v i s i o n o f C e r b r o v a s c u l a r S u r g e r y a n d In t e r v e n t io n a l N e u r o r a d i o l o g y , T h o m a s Je ffe r s o n U n i v e r s i t y H o s p i t a l - W i I Is N e u r o s e n s o r y In s titu te , P h i l a d e l p h i a , P e n n s y l v a n i a OBJECTIVES: To determine if a w indow of time could be defined during w hich angioplasty would be most effective in reversing neurological decline and ultimately improving outcome. METHODS: O f a group of 466 patients, 93 underwent endovascular management of clinical vasospasm that was medically refractory. Eighty-four of the 93 patients were available for follow-up for at least 6 months. All patients underwent m echanical angioplasty using compliant microballoon systems and, if distal spasm was present, the administration of papaverine. RESULTS: Fifty-one patients underwent endovascular management within a 2-hour window , and 33 patients underwent treatment more than 2 hours after the development of their symptoms. Compared with the group treated more than 2 hours after neurological decline (P < 0.01; x 2 = 8.02), the group that underwent endovascular management within a 2-hour window after the development of symptoms demonstrated sustained clinical improvement. C O N C LU S IO N : W hen a patient develops symptomatic vasospasm and is unresponsive to traditional measures of critical care management, angioplasty may be effective in improving the patient's neurological status if this procedure is performed as early as possible. The results indicate that a 2-hour w indow may exist for restoration of blood flow to ultimately improve the patient's outcome. (Neurosurgery 4 4...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199905000-00022
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVETo determine if a window of time could be defined during which angioplasty would be most effective in reversing neurological decline and ultimately improving outcome.METHODSOf a group of 466 patients, 93 underwent endovascular management of clinical vasospasm that was medically refractory. Eighty-four of the 93 patients were available for follow-up for at least 6 months. All patients underwent mechanical angioplasty using compliant microballoon systems and, if distal spasm was present, the administration of papaverine.RESULTSFifty-one patients underwent endovascular management within a 2-hour window, and 33 patients underwent treatment more than 2 hours after the development of their symptoms. Compared with the group treated more than 2 hours after neurological decline (P < 0.01; χ2 = 8.02), the group that underwent endovascular management within a 2-hour window after the development of symptoms demonstrated sustained clinical improvement.CONCLUSIONWhen a patient develops symptomatic vasospasm and is unresponsive to traditional measures of critical care management, angioplasty may be effective in improving the patient's neurological status if this procedure is performed as early as possible. The results indicate that a 2-hour window may exist for restoration of blood flow to ultimately improve the patient's outcome.

Journal

NeurosurgeryOxford University Press

Published: May 1, 1999

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