Endovascular Therapy for Cerebral Vasospasm Following Aneurysmal Subarachnoid Haemorrhage
YTA Lai, CY Chu, HT Sung, CW Tang, KW Leung, SWS Lo, LSJ Khoo
Hong Kong J Radiol 2017;20:140-5
DOI: 10.12809/hkjr1715387
Objectives: To review the treatment and outcome of patients who underwent endovascular therapy for cerebral vasospasm secondary to aneurysmal subarachnoid haemorrhage (SAH).
Methods: Medical records of patients who underwent endovascular therapy at a regional hospital from July 2014 to June 2015 for cerebral vasospasm secondary to aneurysmal SAH were reviewed.
Results: Six women and one man aged 45 to 78 (mean, 56) years had grade-4 aneurysmal SAH and underwent 16 consecutive sessions of endovascular therapy for vasospasm after a mean of 7.5 (range, 4-12) days. They were followed up for at least 10 months. Intra-arterial verapamil was administered at all 16 sessions. In six of the 16 sessions, verapamil injection was followed by percutaneous transluminal balloon angioplasty. All but one session resulted in an immediate angiographic response. There was no treatment-related death or procedural complication. Four patients were free of major motor impairment and had immediate clinical improvement. The remaining three patients had poor outcome or died; all required repeat angioplasty and showed no immediate clinical improvement.
Conclusion: Endovascular therapy is a viable option for cerebral vasospasm secondary to aneurysmal SAH.
Authors’ affiliation:
YTA Lai, CY Chu, HT Sung, CW Tang, KW Leung, SWS Lo, LSJ Khoo: Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
中文摘要
血管治療動脈瘤蛛網膜下腔出血引致的腦血管痙攣
黎爾德、朱志揚、宋咸東、鄧峻樺、梁錦榮、盧成瑋、邱麗珊
目的：回顧動脈瘤蛛網膜下腔出血（SAH）引致的腦血管痙攣的治療和結果。
方法：回顧2014年7月至2015年6月在一間分區醫院接受血管治療動脈瘤SAH引致的腦血管痙攣的患者病歷。
結果：6名女性和1名男性年約45-78（平均，56）歲的患者均有4級動脈瘤SAH，並在平均7.5（範圍，4-12）天後接受共16次血管痙攣治療。他們被跟進至少10個月。16個療程均有動脈注射維拉帕米，其中6次跟隨進行經皮腔內球囊血管成形術。除一個療程外，所有療程都有即時血管造影反應。沒有患者有治療相關的死亡或手術併發症。4名患者有即時臨床改善及無重大運動障礙。其餘3名患者效果不佳或死亡；他們沒有即時臨床改善並需接受重複血管成形術。
結論：血管治療動脈瘤（SAH）引致的腦血管痙攣是一項可行選擇。