Current status of endovascular treatment for vasospasm following subarachnoid hemorrhage: analysis of JR-NET2

Neurol Med Chir (Tokyo). 2014;54(2):107-12. doi: 10.2176/nmc.st2013-0149. Epub 2013 Nov 21.

Abstract

Endovascular treatments are employed for cerebral vasospasm following subarachnoid hemorrhage, which is not responded to the medical treatments. However, the effect or complication of the treatments is not known well. Here, we analyzed the data of Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) and revealed current status of the endovascular treatment for the cerebral vasospasm. JR-NET2 is conducted from January 1, 2007 to December 31, 2009. Information on the clinical status, imaging studies, treatment methods, the results of treatment, and status 30 days later were recorded. Totally 645 treatments for 480 patients (mean age, 59.4 years; 72.7% woman) were included. Factors related to the neurological improvement and treatment related complications were statistically analyzed. Treatments for ruptured cerebral aneurysm were direct surgery for 366 cases and endovascular treatment for 253 cases. The timing of the endovascular treatment for the cerebral vasospasm was within 3 hours in 209 cases, 3-6 hours in 158 cases, and more than 6 hours in 158 cases. Intra-arterial vasodilator was employed for the 495 cases and percutaneous transluminal angioplasty for 140 cases. Neurological improvement was observed in 372 cases and radiological improvement was seen in 623 cases. The treatment related complication occurred in 20 cases (3.1%), including 6 cases of intracranial hemorrhage, 5 cases of cerebral ischemia, a case of puncture site trouble, and 8 cases of others. Statistical analysis showed early treatment was related to the neurological improvement. Current status of endovascular treatment for cerebral vasospasm was revealed. Endovascular treatment was effective for vasospasm especially was performed early.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / therapy
  • Angioplasty / adverse effects
  • Angioplasty / methods
  • Angioplasty / statistics & numerical data*
  • Brain Ischemia / etiology
  • Cerebral Angiography
  • Combined Modality Therapy
  • Embolization, Therapeutic / adverse effects
  • Embolization, Therapeutic / methods
  • Embolization, Therapeutic / statistics & numerical data*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / methods
  • Endovascular Procedures / standards*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Health Care Surveys
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / therapy
  • Intracranial Hemorrhages / chemically induced
  • Japan
  • Male
  • Middle Aged
  • Registries
  • Subarachnoid Hemorrhage / complications*
  • Vasodilator Agents / therapeutic use
  • Vasospasm, Intracranial / etiology
  • Vasospasm, Intracranial / therapy*
  • Young Adult

Substances

  • Fibrinolytic Agents
  • Vasodilator Agents