Marked Reduction of Cerebral Vasospasm with Intrathecal Urokinase Infusion Therapy after Endovascular Coil Embolization of the Aneurysmal Subarachnoid Hemorrhage: A Case Series

Delayed cerebral vasospasms after subarachnoid hemorrhage (SAH) are a risk factor for poor prognosis after successful treatment of ruptured intracranial aneurysms. Different strategies to remove clots from the subarachnoid space and prevent vasospasms have different outcomes. Intrathecal urokinase i...

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Bibliographic Details
Published in:Neurologia Medico-Chirurgica 2022/12/15, Vol.62(12), pp.566-574
Main Authors: NAGAI, Arata, SUZUKI, Yasuhiro, ISHIDA, Tomohisa, SATO, Yoshimichi, INOUE, Tomoo, TOMINAGA, Teiji
Format: Article
Language:English
Subjects:
Aneurysm
Cardiovascular system
Cerebral hemispheres
coil embolization
Embolization
Endovascular coiling
Intravenous therapy
Original
Patients
Risk factors
Subarachnoid hemorrhage
Subarachnoid space
U-Plasminogen activator
urokinase
Vasoconstriction
vasospasm
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Summary:Delayed cerebral vasospasms after subarachnoid hemorrhage (SAH) are a risk factor for poor prognosis after successful treatment of ruptured intracranial aneurysms. Different strategies to remove clots from the subarachnoid space and prevent vasospasms have different outcomes. Intrathecal urokinase infusion therapy combined with endovascular treatment (EVT) can reduce the incidence of symptomatic vasospasms. To analyze the relationship between symptomatic vasospasms and residual SAHs after urokinase infusion therapy, we retrospectively reviewed the records of 348 consecutive patients managed with EVT and intrathecal urokinase infusion therapy for aneurysmal SAH at our institution between 2010 and 2021. Among them, 163 patients met the study criteria and were classified into two groups according to the presence of residual SAH in the cisterns, Sylvian fissures, and frontal interhemispheric fissure. The incidence of symptomatic vasospasms and the clinical outcomes were assessed. In total, eight (5.0%) patients developed symptomatic vasospasms. Patients with symptomatic vasospasms had a significantly higher incidence of residual SAH in the Sylvian or frontal interhemispheric fissures than those without (P
ISSN:0470-8105
1349-8029
DOI:10.2176/jns-nmc.2022-0155