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<meta name="DC.Title" content="Endovascular Treatment of Medically Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2183" />
<meta name="DC.Date" content="2010-11-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: CV following aneurysmal SAH is a significant cause of morbidity and mortality. We review our experiences using PTA and IA verapamil infusion for treating medically refractory cases.

MATERIALS AND METHODS: We performed a retrospective review of patients with SAH admitted from July 2003 to January 2008.

RESULTS: Of 546 patients admitted within 72 hours of symptom onset, 231 patients (42%) developed symptomatic CV and 189 patients (35%) required endovascular therapy. A total of 346 endovascular sessions were performed consisting of 1 single angioplasty, 286 IA verapamil infusions, and 59 combined treatments. PTA was performed on 151 vessel segments, and IA verapamil was infused in 720 vessel segments. IA verapamil doses ranged from 2.0 to 30.0 mg per vessel segment and from 3.0 to 55.0 mg per treatment session. Repeat treatments were necessary in 102 patients (54%) for persistent, recurrent, or worsening CV. There were 6 treatment-related complications, of which 2 resulted in clinical worsening. No deaths were attributable to endovascular therapy. At follow-up, 115 patients (61%) had a good outcome and 55 patients (29%) had a poor outcome. Sixteen patients died from causes related to SAH, while 3 died from other medical complications.

CONCLUSIONS: Endovascular treatments are an integral part of managing patients with medically refractory CV. In our experience, PTA and IA verapamil are safe, with a low complication rate, but further studies are required to determine appropriate patient selection and treatment efficacy.

ACA
:   anterior cerebral artery
CBF
:   cerebral blood flow
CCA
:   common carotid artery
CV
:   cerebral vasospasm
DSA
:   digital subtraction angiogram
HH
:   Hunt and Hess scale
IA
:   intra-arterial
ICA
:   internal carotid artery
ICP
:   intracranial pressure
ISAT
:   International Subarachnoid Aneurysm Trial
MCA
:   middle cerebral artery
mRS
:   modified Rankin Scale
PCA
:   posterior cerebral artery
PTA
:   percutaneous transluminal angioplasty
SAH
:   subarachnoid hemorrhage
TCD
:   transcranial Doppler
UCSF
:   University of California, San Francisco" />
<meta name="DC.Contributor" content="P. Jun" />
<meta name="DC.Contributor" content="N.U. Ko" />
<meta name="DC.Contributor" content="J.D. English" />
<meta name="DC.Contributor" content="C.F. Dowd" />
<meta name="DC.Contributor" content="V.V. Halbach" />
<meta name="DC.Contributor" content="R.T. Higashida" />
<meta name="DC.Contributor" content="M.T. Lawton" />
<meta name="DC.Contributor" content="S.W. Hetts" />
<meta name="article:published_time" content="2010-11-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Endovascular Treatment of Medically Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;CV following aneurysmal SAH is a significant cause of morbidity and mortality. We review our experiences using PTA and IA verapamil infusion for treating medically refractory cases.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We performed a retrospective review of patients with SAH admitted from July 2003 to January 2008.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Of 546 patients admitted within 72 hours of symptom onset, 231 patients (42%) developed symptomatic CV and 189 patients (35%) required endovascular therapy. A total of 346 endovascular sessions were performed consisting of 1 single angioplasty, 286 IA verapamil infusions, and 59 combined treatments. PTA was performed on 151 vessel segments, and IA verapamil was infused in 720 vessel segments. IA verapamil doses ranged from 2.0 to 30.0 mg per vessel segment and from 3.0 to 55.0 mg per treatment session. Repeat treatments were necessary in 102 patients (54%) for persistent, recurrent, or worsening CV. There were 6 treatment-related complications, of which 2 resulted in clinical worsening. No deaths were attributable to endovascular therapy. At follow-up, 115 patients (61%) had a good outcome and 55 patients (29%) had a poor outcome. Sixteen patients died from causes related to SAH, while 3 died from other medical complications.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Endovascular treatments are an integral part of managing patients with medically refractory CV. In our experience, PTA and IA verapamil are safe, with a low complication rate, but further studies are required to determine appropriate patient selection and treatment efficacy.&lt;/p&gt;" />
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<meta name="twitter:title" content="Endovascular Treatment of Medically Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: CV following aneurysmal SAH is a significant cause of morbidity and mortality. We review our experiences using PTA and IA verapamil infusion for treating medically refractory cases.

MATERIALS AND METHODS: We performed a retrospective review of patients with SAH admitted from July 2003 to January 2008.

RESULTS: Of 546 patients admitted within 72 hours of symptom onset, 231 patients (42%) developed symptomatic CV and 189 patients (35%) required endovascular therapy. A total of 346 endovascular sessions were performed consisting of 1 single angioplasty, 286 IA verapamil infusions, and 59 combined treatments. PTA was performed on 151 vessel segments, and IA verapamil was infused in 720 vessel segments. IA verapamil doses ranged from 2.0 to 30.0 mg per vessel segment and from 3.0 to 55.0 mg per treatment session. Repeat treatments were necessary in 102 patients (54%) for persistent, recurrent, or worsening CV. There were 6 treatment-related complications, of which 2 resulted in clinical worsening. No deaths were attributable to endovascular therapy. At follow-up, 115 patients (61%) had a good outcome and 55 patients (29%) had a poor outcome. Sixteen patients died from causes related to SAH, while 3 died from other medical complications.

CONCLUSIONS: Endovascular treatments are an integral part of managing patients with medically refractory CV. In our experience, PTA and IA verapamil are safe, with a low complication rate, but further studies are required to determine appropriate patient selection and treatment efficacy.

ACA
:   anterior cerebral artery
CBF
:   cerebral blood flow
CCA
:   common carotid artery
CV
:   cerebral vasospasm
DSA
:   digital subtraction angiogram
HH
:   Hunt and Hess scale
IA
:   intra-arterial
ICA
:   internal carotid artery
ICP
:   intracranial pressure
ISAT
:   International Subarachnoid Aneurysm Trial
MCA
:   middle cerebral artery
mRS
:   modified Rankin Scale
PCA
:   posterior cerebral artery
PTA
:   percutaneous transluminal angioplasty
SAH
:   subarachnoid hemorrhage
TCD
:   transcranial Doppler
UCSF
:   University of California, San Francisco" />
<meta name="og-title" property="og:title" content="Endovascular Treatment of Medically Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/10/1911" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: CV following aneurysmal SAH is a significant cause of morbidity and mortality. We review our experiences using PTA and IA verapamil infusion for treating medically refractory cases.

MATERIALS AND METHODS: We performed a retrospective review of patients with SAH admitted from July 2003 to January 2008.

RESULTS: Of 546 patients admitted within 72 hours of symptom onset, 231 patients (42%) developed symptomatic CV and 189 patients (35%) required endovascular therapy. A total of 346 endovascular sessions were performed consisting of 1 single angioplasty, 286 IA verapamil infusions, and 59 combined treatments. PTA was performed on 151 vessel segments, and IA verapamil was infused in 720 vessel segments. IA verapamil doses ranged from 2.0 to 30.0 mg per vessel segment and from 3.0 to 55.0 mg per treatment session. Repeat treatments were necessary in 102 patients (54%) for persistent, recurrent, or worsening CV. There were 6 treatment-related complications, of which 2 resulted in clinical worsening. No deaths were attributable to endovascular therapy. At follow-up, 115 patients (61%) had a good outcome and 55 patients (29%) had a poor outcome. Sixteen patients died from causes related to SAH, while 3 died from other medical complications.

CONCLUSIONS: Endovascular treatments are an integral part of managing patients with medically refractory CV. In our experience, PTA and IA verapamil are safe, with a low complication rate, but further studies are required to determine appropriate patient selection and treatment efficacy.

ACA
:   anterior cerebral artery
CBF
:   cerebral blood flow
CCA
:   common carotid artery
CV
:   cerebral vasospasm
DSA
:   digital subtraction angiogram
HH
:   Hunt and Hess scale
IA
:   intra-arterial
ICA
:   internal carotid artery
ICP
:   intracranial pressure
ISAT
:   International Subarachnoid Aneurysm Trial
MCA
:   middle cerebral artery
mRS
:   modified Rankin Scale
PCA
:   posterior cerebral artery
PTA
:   percutaneous transluminal angioplasty
SAH
:   subarachnoid hemorrhage
TCD
:   transcranial Doppler
UCSF
:   University of California, San Francisco" />
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      <h1 class="highwire-cite-title" id="page-title">Endovascular Treatment of Medically Refractory Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">P. Jun</span>, <span class="highwire-citation-author" data-delta="1">N.U. Ko</span>, <span class="highwire-citation-author" data-delta="2">J.D. English</span>, <span class="highwire-citation-author" data-delta="3">C.F. Dowd</span>, <span class="highwire-citation-author" data-delta="4">V.V. Halbach</span>, <span class="highwire-citation-author" data-delta="5">R.T. Higashida</span>, <span class="highwire-citation-author" data-delta="6">M.T. Lawton</span> and <span class="highwire-citation-author" data-delta="7">S.W. Hetts</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1911-1916; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2183 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9701--81529486142" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">P. Jun </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BJun%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jun%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.%2BJun%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">N.U. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">P. Jun</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">N.U. Ko</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-3"><span class="name">J.D. English</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-4"><span class="name">C.F. Dowd</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-5"><span class="name">V.V. Halbach</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-6"><span class="name">R.T. Higashida</span><a id="xref-aff-1-5" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-7"><span class="name">M.T. Lawton</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a> and </li><li class="last" id="contrib-8"><span class="name">S.W. Hetts</span><a id="xref-aff-1-6" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Departments of Radiology (P.J., J.D.E., C.F.D., V.V.H., R.T.H., S.W.H.)</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Neurology (N.U.K., J.D.E.)</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Neurosurgery (M.T.L.), University of California, San Francisco, California.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Steven W. Hetts, MD, <span class="addr-line">Department of Radiology, University of California, 505 Parnassus Ave, L-352, San Francisco, CA 94143-0628</span>; e-mail: <span class="em-link"><span class="em-addr">steven.hetts{at}radiology.ucsf.edu</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/10/1911.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1911-1916; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2183 </span></div>
  
  
  
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