THE EFFECT OF ENDOVASCULAR THERAPY FOR CEREBRAL ARTERIAL SPASM, ITS LIMITATION AND PITFALLS

Purpose: The effect of endovascular treatment for vasospasm was invest igated by analysing the results of patients treated in Wakayama City i n 1994. Materials and Methods: Ninty nine patients with ruptured cereb ral aneurysms, who survived more than one week and were treated in Wak ayama City in 1994, were studied. Twenty five patients caused symptoma tic vasospasm and 25 were treated by endovascular therapy, percutaneou s transluminal angioplasty (PTA) and/or intra-arterial papaverine infu sion (IAP). PTA was performed for proximal vasospasm which located in the main arterial trunk, such as ICA, M1, BA (n = 3). IAP was chosen f or distal vasospasm which located mainly in the M2, Al, A2 (n = 12). P TA and/or IAP was performed for diffuse vasospasm which located in pro ximal and distal arteries (n = 10). Results: In the proximal vasospasm group, all patients were good to moderately disabled on the Glasgow o utcome scale (GOS). In the distal vasospasm group, 8 patients were goo d to moderately disabled, and 4 patients were severely disabled. The o verall results were as follows: 17 (68%), good to moderately disabled, 4 (16%), severely disabled, 4 (16%), dead. The morbidity and mortalit y rate was 8/25 (32%) in symptomatic spasm group. Conclusion: PTA was very effective especially for proximal vasospasm, but IAP was not alwa ys effective for distal or diffuse vasospasm. Diffuse vasospasm reveal ed a high mortality rate in spite of the endovascular therapy.