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Neurocritical Care
Published in: Neurocritical Care 2/2011

01-10-2011 | Review

Critical Care Guidelines on the Endovascular Management of Cerebral Vasospasm

Authors: Matthew M. Kimball, Gregory J. Velat, Brian L. Hoh, The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage

Published in: Neurocritical Care | Issue 2/2011

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Abstract

Cerebral vasospasm and delayed cerebral ischemia account for significant morbidity and mortality after aneurysmal subarachnoid hemorrhage. While most patients are managed with triple-H therapy, endovascular treatments have been used when triple-H treatment cannot be used or is ineffective. An electronic literature search was conducted to identify English language articles published through October 2010 that addressed endovascular management of vasospasm. A total of 49 articles were identified, addressing endovascular treatment timing, intra-arterial treatments, and balloon angioplasty. Most of the available studies investigated intra-arterial papaverine or balloon angioplasty. Both have generally been shown to successfully treat vasospasm and improve neurological condition, with no clear benefit from one treatment compared with another. There are reports of complications with both therapies including vessel rupture during angioplasty, intracranial hypertension, and possible neurotoxicity associated with papaverine. Limited data are available evaluating nicardipine or verapamil, with positive benefits reported with nicardipine and inconsistent benefits with verapamil.
Literature
1.
Fisher CM, Roberson GH, Ojemann RG. Cerebral vasospasm with ruptured saccular aneurysm: the clinical manifestations. Neurosurgery. 1977;1:245–8.PubMedCrossRef
2.
Heros RC, Zervas NT, Varsos V. Cerebral vasospasm after subarachnoid hemorrhage: an update. Ann Neurol. 1983;14:599–608.PubMedCrossRef
3.
Haley EC Jr, Kassell NF, Torner JC. The international cooperative study on the timing of aneurysm surgery. The North American experience. Stroke. 1992;23:205–14.PubMedCrossRef
4.
Longstreth WT Jr, Nelson LM, Koepsell TD, van Belle G. Clinical course of spontaneous subarachnoid hemorrhage: a population-based study in King County, Washington. Neurology. 1993;43:712–8.PubMed
5.
Egge A, Waterloo K, Sjoholm H, Solberg T, Ingebrigtsen T, Romner B. Prophylactic hyperdynamic postoperative fluid therapy after aneurysmal subarachnoid hemorrhage: a clinical, prospective, randomized, controlled study. Neurosurgery. 2001;49:593–605.PubMed
6.
Group GW. Education and debate: grading quality of evidence and strength of recommendations. BMJ. 2004;328:1–8.CrossRef
7.
Zwienenberg-Lee M, Hartman J, Rudisill N, et al. Effect of prophylactic transluminal balloon angioplasty on cerebral vasospasm and outcome in patients with Fisher grade III subarachnoid hemorrhage: results of a phase II multicenter, randomized, clinical trial. Stroke. 2008;39:1759–65.PubMedCrossRef
8.
Rosenwasser RH, Armonda RA, Thomas JE, Benitez RP, Gannon PM, Harrop J. Therapeutic modalities for the management of cerebral vasospasm: timing of endovascular options. Neurosurgery. 1999;44:975–9.PubMedCrossRef
9.
Bejjani GK, Bank WO, Olan WJ, Sekhar LN. The efficacy and safety of angioplasty for cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery. 1998;42:979–86.PubMedCrossRef
10.
Hoh BL, Ogilvy CS. Endovascular treatment of cerebral vasospasm: transluminal balloon angioplasty, intra-arterial papaverine, and intra-arterial nicardipine. Neurosurg Clin N Am. 2005;16:1501–16.CrossRef
11.
Kassell NF, Helm G, Simmons N, Phillips CD, Cail WS. Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg. 1992;77:848–52.PubMedCrossRef
12.
Kaku Y, Yonekawa Y, Tsukahara T, Kazekawa K. Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg. 1992;77:842–7.PubMedCrossRef
13.
Clouston JE, Numaguchi Y, Zoarski GH, Aldrich EF, Simard JM, Zitnay KM. Intraarterial papaverine infusion for cerebral vasospasm after subarachnoid hemorrhage. Am J Neuroradiol. 1995;6:27–38.
14.
Dalbasti T, Karabiyikoglu M, Ozdamar N, Oktar N, Cagli S. Efficacy of controlled-release papaverine pellets in preventing symptomatic cerebral vasospasm. J Neurosurg. 2001;95:44–50.PubMedCrossRef
15.
Fandino J, Kaku Y, Schuknecht B, Valavanis A, Yonekawa Y. Improvement of cerebral oxygenation patterns and metabolic validation of super selective intraarterial infusion of papaverine for the treatment of cerebral vasospasm. J Neurosurg. 1998;89:93–100.PubMedCrossRef
16.
Firlik KS, Kaufmann AM, Firlik AD, Jungreis CA, Yonas H. Intra-arterial papaverine for the treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Surg Neurol. 1999;51:66–74.PubMedCrossRef
17.
Little N, Morgan MK, Grinnell V, Sorby W. Intra-arterial papaverine in the management of cerebral vasospasm following subarachnoid haemorrhage. J Clin Neurosci. 1994;1:42–6.PubMedCrossRef
18.
Liu JK, Tenner MS, Gottfried ON, et al. Efficacy of multiple intraarterial papaverine infusions for improvement in cerebral circulation time in patients with recurrent cerebral vasospasm. J Neurosurg. 2004;100:414–21.PubMedCrossRef
19.
Morgan MK, Jonker B, Finfer S, Harrington T, Dorsch NW. Aggressive management of aneurysmal subarachnoid haemorrhage based on a papaverine angioplasty protocol. J Clin Neurosci. 2000;7:305–8.PubMedCrossRef
20.
Numaguchi Y, Zoarski GH. Intra-arterial papaverine treatment for cerebral vasospasm: our experience and review of the literature. Neurol Med Chir (Tokyo). 1998;38:189–95.CrossRef
21.
Segawa H, Saito I, Okada T, et al. Efficacy of intracisternal papaverine on symptomatic vasospasm. No Shinkei Geka. 1986;14:847–54.PubMed
22.
Yoshimura S, Tsukahara T, Hashimoto N, Kazekawa K, Kobayashi A. Intra-arterial infusion of papaverine combined with intravenous administration of high-dose nicardipine for cerebral vasospasm. Acta Neurochir (Wien). 1995;135:186–90.CrossRef
23.
Polin RS, Hansen CA, German P, Chadduck JB, Kassell NF. Intra-arterially administered papaverine for the treatment of symptomatic cerebral vasospasm. Neurosurgery. 1998;42:1256–64.PubMedCrossRef
24.
Sawada M, Hashimoto N, Tsukahara T, Nishi S, Kaku Y, Yoshimura S. Effectiveness of intra-arterially infused papaverine solutions of various concentrations for the treatment of cerebral vasospasm. Acta Neurochir (Wien). 1997;139:706–11.CrossRef
25.
Smith WS, Dowd CF, Johnston SC, et al. Neurotoxicity of intra-arterial papaverine preserved with chlorobutanol used for the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke. 2004;35:2518–22.PubMedCrossRef
26.
Albanese ERA, Quiroga M, Willis RN, Mericle RA, Ulm AJ. Ultrahigh-dose intraarterial infusion of verapamil through an indwelling micro catheter for medically refractory severe vasospasm: initial experience. J Neurosurg. 2010;113:913–22.PubMedCrossRef
27.
Feng L, Fitzsimmons BF, Young WL, et al. Intraarterially administered verapamil as adjunct therapy for cerebral vasospasm: safety and 2-year experience. Am J Neuroradiol. 2002;23:1284–90.PubMed
28.
Keuskamp J, Murali R, Chao KH. High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2008;108:458–63.PubMedCrossRef
29.
Mazumdar A, Rivet DJ, Derdeyn CP, Cross DT III, Moran CJ. Effect of intraarterial verapamil on the diameter of vasospastic intracranial arteries in patients with cerebral vasospasm. Neurosurg Focus. 2006;21:E15.PubMedCrossRef
30.
Badjatia N, Topcuoglu MA, Pryor JC, et al. Preliminary experience with intra-arterial nicardipine as a treatment for cerebral vasospasm. Am J Neuroradiol. 2004;25:819–26.PubMed
31.
Linfante I, Delgado-Mederos R, Andreone V, Gounis M, Hendricks L, Wakhloo AK. Angiographic and hemodynamic effect of high concentration of intra-arterial nicardipine in cerebral vasospasm. Neurosurgery. 2008;63:1080–6.PubMedCrossRef
32.
Tejada JG, Taylor RA, Ugurel MS, Hayakawa M, Lee SK, Chaloupka JC. Safety and feasibility of intra-arterial nicardipine for the treatment of subarachnoid hemorrhage-associated vasospasm: initial clinical experience with high-dose infusions. Am J Neuroradiol. 2007;28:844–8.PubMed
33.
Andaluz N, Tomsick TA, Tew JM Jr, van Loveren HR, Yeh HS, Zuccarello M. Indications for endovascular therapy for refractory vasospasm after aneurysmal subarachnoid hemorrhage: experience at the University of Cincinnati. Surg Neurol. 2002;58:131–8.PubMedCrossRef
34.
Armonda RA, Thomas JE, Rosenwasser RH. Early and aggressive treatment of medically intractable cerebral vasospasm with pentobarbital coma, cerebral angioplasty and ICP reduction. Neurosurg Focus. 1998;5:e7.PubMed
35.
Beck J, Raabe A, Lanfermann H, et al. Effects of balloon angioplasty on perfusion- and diffusion-weighted magnetic resonance imaging results and outcome in patients with cerebral vasospasm. J Neurosurg. 2006;105:220–7.PubMedCrossRef
36.
Coyne TJ, Montanera WJ, Macdonald RL, Wallace MC. Percutaneous transluminal angioplasty for cerebral vasospasm after subarachnoid hemorrhage. Can J Surg. 1994;37:391–6.PubMed
37.
Elliott JP, Newell DW, Lam DJ, et al. Comparison of balloon angioplasty and papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 1998;88:277–84.PubMedCrossRef
38.
Eskridge JM, McAuliffe W, Song JK, et al. Balloon angioplasty for the treatment of vasospasm: results of first 50 cases. Neurosurgery. 1998;42:510–6.PubMedCrossRef
39.
Eskridge JMND, Pendleton GA. Transluminal angioplasty for treatment of vasospasm. Neurosurg Clin N Am. 1990;1:387–99.PubMed
40.
Firlik AD, Kaufmann AM, Jungreis CA, Yonas H. Effect of transluminal angioplasty on cerebral blood flow in the management of symptomatic vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 1997;86:830–9.PubMedCrossRef
41.
Fujii Y, Takahashi A, Yoshimoto T. Effect of balloon angioplasty on high grade symptomatic vasospasm after subarachnoid hemorrhage. Neurosurg Rev. 1995;18:7–13.PubMedCrossRef
42.
Higashida RT, Halbach VV, Cahan LD, et al. Transluminal angioplasty for treatment of intracranial arterial vasospasm. J Neurosurg. 1989;71:648–53.PubMedCrossRef
43.
Higashida RT, Halbach VV, Dormandy B, Bell J, Brant-Zawadzki M, Hieshima GB. New microballoon device for transluminal angioplasty of intracranial arterial vasospasm. Am J Neuroradiol. 1990;11:233–8.PubMed
44.
Higashida RT, Halbach VV, Dowd CF, Dormandy B, Bell J, Hieshima GB. Intravascular balloon dilatation therapy for intracranial arterial vasospasm: patient selection, technique, and clinical results. Neurosurg Rev. 1992;15:89–95.PubMedCrossRef
45.
Jestaedt L, Pham M, Bartsch AJ, et al. The impact of balloon angioplasty on the evolution of vasospasm-related infarction after aneurysmal subarachnoid hemorrhage. Neurosurgery, in press.
46.
Katoh H, Shima K, Shimizu A, et al. Clinical evaluation of the effect of percutaneous transluminal angioplasty and intra-arterial papaverine infusion for the treatment of vasospasm following aneurysmal subarachnoid hemorrhage. Neurol Res. 1999;21:195–203.PubMed
47.
Muizelaar JP, Zwienenberg M, Mini NA, Hecht ST. Safety and efficacy of transluminal balloon angioplasty in the prevention of vasospasm in patients with Fisher grade 3 subarachnoid hemorrhage: a pilot study. Neurosurg Focus. 1998;5:e5.PubMedCrossRef
48.
Muizelaar JP, Zwienenberg M, Rudisill NA, Hecht ST. The prophylactic use of transluminal balloon angioplasty in patients with Fisher grade 3 subarachnoid hemorrhage: a pilot study. J Neurosurg. 1999;91:51–8.PubMedCrossRef
49.
Newell DW, Eskridge JM, Mayberg MR, Grady MS, Winn HR. Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. J Neurosurg. 1989;71:654–60.PubMedCrossRef
50.
Terry A, Zipfel G, Milner E, et al. Safety and technical efficacy of over-the-wire balloons for the treatment of subarachnoid hemorrhage-induced cerebral vasospasm. Neurosurg Focus. 2006;21:E14.PubMedCrossRef
51.
Turowski B, de Rochemont R, Beck J, Berkefeld J, Zanella FE. Assessment of changes in cerebral circulation time due to vasospasm in a specific arterial territory: effect of angioplasty. Neuroradiology. 2005;37:134–43.CrossRef
52.
Zubkov YN, Nikiforov BM, Shustin VA. Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir (Wien). 1984;70:65–79.CrossRef
53.
Lewis DHPEJ, Newell DW, Eskridge JM, Richard Winn H. Interventional endovascular therapy: SPECT cerebral blood flow imaging compared with transcranial Doppler monitoring of balloon angioplasty and intraarterial papaverine for cerebral vasospasm. J Stroke Cerebrovasc Dis. 1999;8:71–5.PubMedCrossRef
54.
Coenen VA, Hansen CA, Kassell NF, Polin RS. Endovascular treatment for symptomatic cerebral vasospasm after subarachnoid hemorrhage: transluminal balloon angioplasty compared with intraarterial papaverine. Neurosurg Focus. 1998;5:e6.PubMedCrossRef
55.
Polin RS, Coenen VA, Hansen CA, et al. Efficacy of transluminal angioplasty for the management of symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2000;92:284–90.PubMedCrossRef
Metadata
Title
Critical Care Guidelines on the Endovascular Management of Cerebral Vasospasm
Authors
Matthew M. Kimball
Gregory J. Velat
Brian L. Hoh
The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage
Publication date
01-10-2011
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 2/2011
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-011-9600-1

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