Feasibility and Safety of Repeat Instant Endovascular Interventions in Patients with Refractory Cerebral Vasospasms.

Andereggen, Lukas; Beck, Jürgen; Z'Graggen, Werner Josef; Schroth, Gerhard; Andres, R H; Murek, Michael; Hänggi, Matthias; Reinert, M; Raabe, Andreas; Gralla, Jan (2017). Feasibility and Safety of Repeat Instant Endovascular Interventions in Patients with Refractory Cerebral Vasospasms. AJNR. American journal of neuroradiology, 38(3), pp. 561-567. American Society of Neuroradiology 10.3174/ajnr.A5024

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BACKGROUND AND PURPOSE For patients with cerebral vasospasm refractory to medical and hemodynamic therapies, endovascular therapies often remain the last resort. Data from studies in large cohorts on the efficacy and safety of multiple immediate endovascular interventions are sparse. Our aim was to assess the feasibility and safety of multiple repeat instant endovascular interventions in patients with cerebral vasospasm refractory to medical, hemodynamic, and initial endovascular interventions. MATERIALS AND METHODS This was a single-center retrospective study of prospectively collected data on patients with cerebral vasospasm refractory to therapies requiring ≥3 endovascular interventions during the course of treatment following aneurysmal subarachnoid hemorrhage. The primary end point was functional outcome at last follow-up (mRS ≤2). The secondary end point was angiographic response to endovascular therapies and the appearance of cerebral infarctions. RESULTS During a 4-year period, 365 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Thirty-one (8.5%) met the inclusion criteria. In 52 (14%) patients, ≤2 endovascular interventions were performed as rescue therapy for refractory cerebral vasospasm. At last follow-up, a good outcome was noted in 18 (58%) patients with ≥3 interventions compared with 31 (61%) of those with ≤2 interventions (P = .82). The initial Hunt and Hess score of ≤2 was a significant independent predictor of good outcome (OR, 4.7; 95% CI, 1.2-18.5; P = .03), whereas infarcts in eloquent brain areas were significantly associated with a poor outcome (mRS 3-6; OR, 13.5; 95% CI, 2.3-81.2; P = .004). CONCLUSIONS Repeat instant endovascular intervention is an aggressive but feasible last resort treatment strategy with a favorable outcome in two-thirds of patients with refractory cerebral vasospasm and in whom endovascular treatment has already been initiated.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Andereggen, Lukas; Beck, Jürgen; Z'Graggen, Werner Josef; Schroth, Gerhard; Murek, Michael; Hänggi, Matthias; Raabe, Andreas and Gralla, Jan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1936-959X

Publisher:

American Society of Neuroradiology

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

09 Jan 2017 13:48

Last Modified:

16 Mar 2017 01:30

Publisher DOI:

10.3174/ajnr.A5024

PubMed ID:

27979797

BORIS DOI:

10.7892/boris.92173

URI:

https://boris.unibe.ch/id/eprint/92173

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