INCIDENCE OF CEREBRAL VASOSPASM AFTER ENDOVASCULAR TREATMENT OF ACUTELY RUPTURED ANEURYSMS - REPORT ON 69 CASES

Cerebral vasospasm is the most common cause of morbidity and mortality in patients admitted to the hospital after suffering aneurysmal subar achnoid hemorrhage (SAH). The early surgical removal of subarachnoid d ots and irrigation of the basal cisterns have been reported to reduce the incidence of vasospasm. In contrast to surgery, the endovascular t reatment of aneurysms does not allow removal of subarachnoid clots. In this study the authors measured the incidence of symptomatic vasospas m after early endovascular treatment of acutely ruptured aneurysms wit h Guglielmi detachable coils (GDCs). Sixty-Five patients classified as Hunt and Hess Grades I to III underwent occlusion of intracranial ane urysms via GDCs within 72 hours-of rupture. The amount of blood on the initial computerized tomography (CT) scan was classified by means of Fisher's scale. Symptomatic vasospasm was defined as the onset of neur ological deterioration verified with angiographic or transcranial Dopp ler studies. Hypertensive, hypervolemic, hemodilution therapy, with or without intracranial angioplasty, was used to treat vasospasm after C -DC placement. Symptomatic vasospasm occurred in 16 (23%) of 69 patien ts. The clinical grade at admission and the amount of blood on the ini tial CT were both associated with the incidence of subsequent vasospas m. At 6-month clinical follow-up examination, 12 of these 16 patients experienced a good recovery, two were moderately disabled, and two pat ients had died of vasospasm. In conclusion, the 23% incidence of sympt omatic vasospasm in this series compares favorably with that found in conventional surgical series of patients with acute aneurysmal SAH. Th ese results indicate that endovascular therapy does not have an unfavo rable impact on cerebral vasospasm.