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Chemical angioplasty with spasmolytics for vasospasm after subarachnoid hemorrhage

  • Original Article - Vascular
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Abstract

Background

Clinically symptomatic vasospasm leading to delayed ischemic neurological deficits occurs in up to 30% of patients with subarachnoid hemorrhage (SAH). Vasospasm can result in a serious decline in clinical conditions of patients with SAH, yet the algorithm for vasospasm treatment and prevention remains unclear. Intra-arterial administration of vasodilators is one of the modalities used for vasospasm therapy.

Methods

Over the last 7 years, we have treated 27 female and 7 male patients with vasospasm using intra-arterial administration of either nimodipine or milrinone; all had suffered aneurysm rupture. Of these patients, 28 were treated surgically (clip), and 6 patients had their aneurysm coiled. Spasmolytics were applied from day 2 to day 18 after rupture.

Results

Of the 53 procedures, angiographic improvement was documented in 92% of cases with a mean flow velocity decrease of 65 cm/s. Brain metabolism changes were monitored after the procedure. The highest level of immediate clinical improvement was observed in conscious patients with a focal neurological deficit (aphasia, hemiparesis). Overall clinical outcomes (Glasgow outcome scale, GOS) were as follows: GOS 5 (12 patients), GOS 4 (5 patients), GOS 3 (5 patients), GOS 2 (6 patients), and GOS 1 (6 patients).

Conclusions

Intra-arterial administration of spasmolytics is a safe and potent method of vasospasm treatment. It is most effective when applied to conscious patients with a focal deficit. For unconscious patients, its therapeutic benefits are inconclusive. Patients in severe clinical states would further require use of other diagnostic tools such as multimodal brain monitoring to complement vasospasm therapy.

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Acknowledgements

Supported with a grant from the Ministry of Health of the Czech Republic, IGA NT 13883/4-2012, by project no. LQ1605 from the National Program of Sustainability II (MEYS CR), by FNUSA-ICRC project no. CZ.1.05/1.1.00/02.0123 (OP VaVpI), by Ministry of Education, Youth and Sports of the Czech Republic project no. LH14054 (KONTAKT II) and by the Internal Grant Agency of the KZCR (IGA-KZ-2016-1-9 and IGA-KZCR-2016-12).

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Authors and Affiliations

  1. Department of Neurosurgery of the J.E. Purkinje University, Masaryk Hospital, Sociální péče 12A, Ústí nad Labem, 401 13, Czech Republic

    Aleš Hejčl, Petr Vachata, Robert Bartoš & Martin Sameš

  2. International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic

    Aleš Hejčl

  3. Department of Neurosurgery of the 1st Medical Faculty and the Central Military Hospital, Prague, Czech Republic

    Aleš Hejčl

  4. Department of Tissue Culture and Stem Cells, Institute of Experimental Medicine ASCR, Prague, Czech Republic

    Aleš Hejčl

  5. Department of Radiology, Masaryk Hospital, Ústí nad Labem, Czech Republic

    Filip Cihlář & Vojtěch Smolka

  6. Department of Neurosurgery, University Hospital Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic

    Petr Vachata

  7. Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Ústí nad Labem, Czech Republic

    Jan Procházka

  8. Department of Mathematics, Faculty of Science, J.E. Purkinje University, Ústí nad Labem, Czech Republic

    Jiří Cihlář

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  1. Aleš Hejčl
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  2. Filip Cihlář
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Correspondence to Aleš Hejčl.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent was not feasible.

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Hejčl, A., Cihlář, F., Smolka, V. et al. Chemical angioplasty with spasmolytics for vasospasm after subarachnoid hemorrhage. Acta Neurochir 159, 713–720 (2017). https://doi.org/10.1007/s00701-017-3104-5

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  • DOI: https://doi.org/10.1007/s00701-017-3104-5

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