Incidence of cerebral vasospasm after endovascular treatment of acutely ruptured aneurysms: report on 69 cases
Incidence of cerebral vasospasm after endovascular treatment of acutely ruptured aneurysms: report on 69 cases
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DOI：
10.3171/jns.1997.87.6.0830
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发表时间：
1997-12-01
影响因子：
4.1
通讯作者：
Frazee, J
中科院分区：
文献类型：
--
作者：
Murayama, Y;Malisch, T;Frazee, J
脑血管痉挛是蛛网膜下腔出血（SAH）后住院患者发病和死亡的最常见原因。早期手术切除蛛网膜下点和基底池冲洗已被报道可减少血管痉挛的发生率。与手术相反，动脉瘤的血管内治疗不允许去除蛛网膜下腔凝块。在这项研究中，作者测量了急性破裂动脉瘤早期血管内治疗后的症状性血管痉挛的发生率，其中65名Hunt和Hess分级为I至III级的患者在破裂72小时内通过GDC进行了颅内动脉瘤闭塞。通过Fisher量表对初始计算机断层扫描（CT）扫描的血量进行分类。症状性血管痉挛定义为经血管造影或经颅多普勒检查证实的神经功能恶化。采用高血压、高容量、血液稀释疗法治疗C-DC置入后的血管痉挛，其中16例（23%）发生症状性血管痉挛。入院时的临床分级和首次CT上的出血量均与随后血管痉挛的发生率相关。在6个月的临床随访检查中，这16例患者中有12例恢复良好，2例中度残疾，2例死于血管痉挛。总之，本系列中症状性血管痉挛的发生率为23%，与急性蛛网膜下腔出血患者的传统手术系列相比，具有优势。这些结果表明，血管内治疗对脑血管痉挛没有不利影响。
Cerebral vasospasm is the most common cause of morbidity and mortality in patients admitted to the hospital after suffering aneurysmal subarachnoid hemorrhage (SAH). The early surgical removal of subarachnoid dots and irrigation of the basal cisterns have been reported to reduce the incidence of vasospasm. In contrast to surgery, the endovascular treatment of aneurysms does not allow removal of subarachnoid clots. In this study the authors measured the incidence of symptomatic vasospasm after early endovascular treatment of acutely ruptured aneurysms with Guglielmi detachable coils (GDCs).Sixty-Five patients classified as Hunt and Hess Grades I to III underwent occlusion of intracranial aneurysms via GDCs within 72 hours-of rupture. The amount of blood on the initial computerized tomography (CT) scan was classified by means of Fisher's scale. Symptomatic vasospasm was defined as the onset of neurological deterioration verified with angiographic or transcranial Doppler studies. Hypertensive, hypervolemic, hemodilution therapy, with or without intracranial angioplasty, was used to treat vasospasm after C-DC placement.Symptomatic vasospasm occurred in 16 (23%) of 69 patients. The clinical grade at admission and the amount of blood on the initial CT were both associated with the incidence of subsequent vasospasm. At 6-month clinical follow-up examination, 12 of these 16 patients experienced a good recovery, two were moderately disabled, and two patients had died of vasospasm.In conclusion, the 23% incidence of symptomatic vasospasm in this series compares favorably with that found in conventional surgical series of patients with acute aneurysmal SAH. These results indicate that endovascular therapy does not have an unfavorable impact on cerebral vasospasm.