Endovascular therapy for cerebral vasospasm after aneurysmal subarachnoid hemorrhage: Single-center experience in a high-volume neurovascular unit

• Published in: Brain & spine 2024, Vol.4, p.104133, Article 104133
• Main Authors: Albrecht, Carolin, Liang, Raimunde, Trost, Dominik, Hostettler, Isabel, Renz, Martin, Meyer, Bernhard, Zimmer, Claus, Kirschke, Jan, Maegerlein, Christian, Bodden, Jannis, Lingg, Charlotte, Wagner, Arthur, Boeckh-Behrens, Tobias, Wostrack, Maria, Schwarting, Julian
• Format: Article
• Language: English
• Subjects: Aneurysmal subarachnoid hemorrhage; aSAH; Cerebral vasospasm; CVS; Delayed cerebral ischemia; Subarachnoid hemorrhage; Vascular disorders
• ISSN: 2772-5294; 2772-5294
• DOI: 10.1016/j.bas.2024.104133

Despite targeted standard therapy, aneurysmal subarachnoid hemorrhage (aSAH) frequently leads to cerebral vasospasms (CVS) of large cerebral arteries, reduced oxygen supply of brain tissue, known as delayed cerebral ischemia (DCI), subsequent development of manifest cerebral infarction and poor neurological outcome. The primary aim was to evaluate the efficacy of endovascular spasmolysis (eSL) as a rescue therapy for delayed ischemic neurological deficits (DIND) occurring despite maximum conservative treatment, with the potential benefit of preventing permanent ischemic deficits, and thus, improving overall neurological outcomes. In our retrospective, monocentric study, we included 310 patients developing CVS during hospitalization and evaluated their clinical and radiographic outcomes. Severe vasospasm was defined by a mean velocity of >200 cm/s in transcranial Doppler ultrasound and/or occurrence of new neurological deficits, and/or decrease of at least 2 points on the Glasgow Coma Scale (GCS), respectively. 92 patients (29.7%) underwent eSL due to persistent symptoms despite conservative therapy. Among endovascularly treated patients, 86% (n = 79) improved angiographically, 71% (n = 44) of 62 patients who underwent eSL due to symptomatic deterioration improved clinically. Clinical worsening due to progressive CVS occurred in 18% of cases (n = 11). Periprocedural complications were observed in 4% (n = 4). eSL emerges as a safe and effective therapy for individuals experiencing DIND triggered by large-artery vasospasm following aSAH. The implementation of a standardized, multi-step process for detection and management, coupled with criteria for endovascular interventions, proves to be an efficient preventative approach to enhance neurological outcomes after aSAH. •Endovascular spasmolysis can act as rescue therapy for cerebral vasospasm, but evidence is limited.•Endovascular spasmolysis improved neurological deficits in 71 % of individuals in this large retrospective cohort study.•Standardized detection and management with well-defined criteria for endovascular interventions should be implemented.