Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Murayama, Y. Articles by Viñuela, F. Search for Related Content PubMed PubMed Citation Articles by Murayama, Y. Articles by Viñuela, F.

American Journal of Neuroradiology 24:133-139, January 2003
© 2003 American Society of Neuroradiology

INTERVENTIONAL

Combined Endovascular Treatment for Both Intracranial Aneurysm and Symptomatic Vasospasm

Yuichi Murayama^a, Joon K. Song^a, Ken Uda^a, Y. Pierre Gobin^a, Gary R. Duckwiler^a, Satoshi Tateshima^a, Aman B. Patel^a, Neil A. Martin^b and Fernando Viñuela^a

^a Division of Interventional Neuroradiology, Department of Radiology, University of California at Los Angeles, School of Medicine and Medical Center, Los Angeles
^b Section of Neurovascular Surgery, Division of Neurosurgery, Department of Surgery, University of California at Los Angeles, School of Medicine and Medical Center, Los Angeles

Address reprint requests to Yuichi Murayama, M.D., Division of Interventional Neuroradiology, Department of Radiological Sciences, UCLA School of Medicine and Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90024

BACKGROUND AND PURPOSE: The best strategy for treatment of subarachnoid hemorrhage due to ruptured cerebral aneurysm is obliteration of the aneurysm as soon as possible. Early surgery is desirable if the patient does not develop severe vasospasm or is clinically stable. However, if the patient has already developed severe vasospasm on admission, surgery may carry the risk of increasing the severity. We evaluated the safety and effectiveness of combined Guglielmi detachable coil (GDC) embolization and angioplasty in a single session for the treatment of ruptured aneurysms associated with symptomatic vasospasm.

METHODS: From January 1992 to January 2001, 12 consecutive patients with ruptured aneurysms associated with symptomatic vasospasm were treated. Patients were classified as Hunt and Hess grade 2 (n = 1), 3 (n = 6), 4 (n = 4), or 5 (n = 1) and Fisher CT group 2 (n = 1), 3 (n = 10), or 4 (n = 1). They underwent GDC aneurysm occlusion and balloon angioplasty (n = 6), intraarterial papaverine infusion (n = 2), or both (n = 4) in a single session. In nine patients, aneurysm coil occlusion was performed first.

RESULTS: Complete GDC occlusion was achieved in eight patients, a small neck remnant persisted in three, and embolization was incomplete in one patient. In all patients, angiographic improvement of vasospasm was obtained. In one patient, a thromboembolic complication occurred and was treated with urokinase. Clinical outcomes at discharge were good recovery in six, moderate disability in two, severe disability in three, or death in one.

CONCLUSION: Endovascular treatment can be the first therapeutic option for ruptured aneurysms associated with severe vasospasm on admission. It offers some advantages over surgery in this setting, but these are balanced by the risk of thromboembolism.

This article has been cited by other articles:

				I. Oran and C. Cinar Continuous Intra-Arterial Infusion of Nimodipine During Embolization of Cerebral Aneurysms Associated With Vasospasm AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 291 - 295. [Abstract] [Full Text] [PDF]