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Endovascular management of cerebral vasospasm following aneurysm rupture: outcomes and predictors in 116 patients.

Publication ,  Journal Article
Chalouhi, N; Tjoumakaris, S; Thakkar, V; Theofanis, T; Hammer, C; Hasan, D; Starke, RM; Wu, C; Gonzalez, LF; Rosenwasser, R; Jabbour, P
Published in: Clin Neurol Neurosurg
March 2014

OBJECTIVE: To retrospectively assess the safety and efficacy of endovascular treatment of cerebral vasospasm with different modalities and assess predictors of outcome. METHODS: Endovascular treatment was indicated in the event of neurological deterioration refractory to medical therapy. Data were collected for 116 patients treated at our institution. RESULTS: Vasospasm was treated with balloon angioplasty in 52.6%, intra-arterial nicardipine infusion in 19.8%, or both in 27.6%. Angiographic vasospasm was reversed in all but 4 (96.6%) patients. The complication rate was 0.9%. Twenty patients (17.2%) had incipient pre-procedure hypodensities; 3 (15%) hypodensities were reversed and neurological improvement occurred in 60% of these patients. Retreatment was required in 22 (19%) patients. Higher Hunt and Hess grades and treatment with nicardipine alone predicted retreatment. Neurological improvement was noted in 82%. Male gender, pre-procedure hypodensities, and posterior communicating artery aneurysm location negatively predicted neurological recovery. Favorable outcomes were noted in 73%. Higher Hunt and Hess grades, pre-procedure hypodensities, posterior circulation aneurysms, and no neurological recovery predicted poor outcome. CONCLUSION: Endovascular therapy for vasospasm has an excellent safety-efficacy profile. Balloon angioplasty and nicardipine are equally effective but effects of nicardipine are less durable. Patients with incipient pre-procedure hypodensities benefit from endovascular intervention and should probably not be excluded from treatment.

Duke Scholars

Published In

Clin Neurol Neurosurg

DOI

EISSN

1872-6968

Publication Date

March 2014

Volume

118

Start / End Page

26 / 31

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Vasospasm, Intracranial
  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Subarachnoid Hemorrhage
  • Risk Factors
  • Retrospective Studies
  • Recovery of Function
  • Predictive Value of Tests
  • Nicardipine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chalouhi, N., Tjoumakaris, S., Thakkar, V., Theofanis, T., Hammer, C., Hasan, D., … Jabbour, P. (2014). Endovascular management of cerebral vasospasm following aneurysm rupture: outcomes and predictors in 116 patients. Clin Neurol Neurosurg, 118, 26–31. https://doi.org/10.1016/j.clineuro.2013.12.012
Chalouhi, Nohra, Stavropoula Tjoumakaris, Vismay Thakkar, Thana Theofanis, Christine Hammer, David Hasan, Robert M. Starke, et al. “Endovascular management of cerebral vasospasm following aneurysm rupture: outcomes and predictors in 116 patients.Clin Neurol Neurosurg 118 (March 2014): 26–31. https://doi.org/10.1016/j.clineuro.2013.12.012.
Chalouhi N, Tjoumakaris S, Thakkar V, Theofanis T, Hammer C, Hasan D, et al. Endovascular management of cerebral vasospasm following aneurysm rupture: outcomes and predictors in 116 patients. Clin Neurol Neurosurg. 2014 Mar;118:26–31.
Chalouhi, Nohra, et al. “Endovascular management of cerebral vasospasm following aneurysm rupture: outcomes and predictors in 116 patients.Clin Neurol Neurosurg, vol. 118, Mar. 2014, pp. 26–31. Pubmed, doi:10.1016/j.clineuro.2013.12.012.
Chalouhi N, Tjoumakaris S, Thakkar V, Theofanis T, Hammer C, Hasan D, Starke RM, Wu C, Gonzalez LF, Rosenwasser R, Jabbour P. Endovascular management of cerebral vasospasm following aneurysm rupture: outcomes and predictors in 116 patients. Clin Neurol Neurosurg. 2014 Mar;118:26–31.
Journal cover image

Published In

Clin Neurol Neurosurg

DOI

EISSN

1872-6968

Publication Date

March 2014

Volume

118

Start / End Page

26 / 31

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Vasospasm, Intracranial
  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Subarachnoid Hemorrhage
  • Risk Factors
  • Retrospective Studies
  • Recovery of Function
  • Predictive Value of Tests
  • Nicardipine