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Vasospasm after aneurysmal subarachnoid hemorrhage: recent advances in endovascular management

Pierot, Laurenta; Aggour, Mohameda; Moret, Jacquesb

Current Opinion in Critical Care: April 2010 - Volume 16 - Issue 2 - p 110–116
doi: 10.1097/MCC.0b013e3283372ef2
Neuroscience: Edited by Marek Mirski

Purpose of review In a rapidly advancing specialty, it is essential to review the recent studies of alternative new treatments and present their efficacy, safety and outcome. We discuss the recent advances in the endovascular treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage in the past few years with special focus on the literature regarding this subject in the last 18–24 months.

Recent findings The recent findings are as follows: effect of papaverine on brain oxygen; recent evaluation concerning nimodipine use; combined intraarterial and intravenous use of milrinone; illustration of the numerous recent studies on nicardipine; the safety and efficacy of high-dose intraarterial verapamil; outcome and adverse effects of intraarterial fasudil; transluminal balloon angioplasty; and recent evaluation of its efficacy and evaluation of its prophylactic use.

Summary Endovascular treatment, including intraarterial vasodilators and transluminal balloon angioplasty, has a very important place in the management of symptomatic vasospasm related to aneurysmal subarachnoid hemorrhage. The efficacy of intraarterial vasodilators has been proven. Numerous studies and analysis of different treatments of cerebrovascular vasospasm took place in the past period. This allowed more understanding and evaluation of their outcome, safety and efficacy helping physicians to choose better treatments to adopt. It emphasizes also the aspects that need more study and research.

aNeuroradiology Department, La Maison Blanche Hospital, Reims, France

bRothschild Foundation Hospital, Paris, France

Correspondence to Laurent Pierot, MD, PhD, Department of Neuroradiology, Hospital Maison Blanche, CHU Reims, 45 rue Cognacq Jay, 51100 Reims, France Tel: +33 32 67 88 764; fax: +33 32 67 87 594; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.