Endovascular Management of Subarachnoid Hemorrhage Induced Vasospasm

Abstract

P ast research effort has traditionally been focused on vasospasm, which was conceived to be the sole factor for delayed neurological deficit. The failure of anti-vasospastic drugs to improve outcome in clinical trials has brought into focus the significance of early brain injury. Further research in the pathological mechanisms of early brain injury is needed, which may help uncloaking new therapeutic avenues that can be exploited to serve as combination therapy with anti-vasospasm medications in the future (Caner, Hou et al., 2012) In current clinical practice the most advisable guideline for screening, diagnosis and monitoring of vasospasm and delayed cerebral ischaemia is, in the first place based on clinical examination and transcranial Doppler. Computed tomography techniques and multi-modal magnetic resonance are justified in specific situations. Digital subtraction angiography is the current gold standard for diagnosis of cerebral vasospasm. There is a need for more and higher quality articles about the utility of diagnostic tests in this context (Rodriguez Garcia, Rodriguez Pupo et al., 2010)

Blood pressure or cardiac output optimization should be the mainstay of hyperdynamic therapy and should be the initial treatment for patients with symptomatic vasospasm. The best approach to treating medically refractory vasospasm has not yet been defined. Endovascular treatment appears to have a positive impact on neurological outcome compared with the natural history of the disease. Intrathecal therapy and flow augmentation strategies in association with medical and endovascular treatment may, in the future, play a role in the management of patients with severe refractory vasospasm. Unfortunately, at this point the lack of prospective randomized controlled studies limits any definite conclusions (Dabus and Nogueira, 2013).