Endovascular Treament of Delayed Ischemic Deficits

Endovascular approaches to treatment of vasospasm are continuously evolving. It is now a routine practice to perform angioplasty on the proximal segments of the vasospastic cerebral vessels. The angiographic changes following angioplasty are impressive and appear to be long lasting (Fig. 3). However, clinical efficacy has been difficult to establish, as this procedure is utilized in conjunction

Figure 3 Vasospasm before and after angioplasty. (A) Angiogram with vasospasm in the middle cerebral artery territory (thin arrow). (B) Angiogram after angioplasty with improvement in vasospasm (thick arrow).

with HA. In addition to angioplasty, intra-arterial infusion of papaverine results in vasodilation and improvement in global blood flow, but the response is transient and repeated treatments are often necessary. Calcium channel blockers have also been employed with good angiographic results.

The most efficacious point at which to move to endovascular interventions remains unsettled. Most centers initiate hemodynamic augmentation first, and, if no response occurs in a matter of hours, proceed to endovascular interventions. Patients with poor cardiac function, however, might be candidates for prompt endovascular management, because they are at a high risk of complications from hemodynamic augmentation.

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