Endovascular management of cerebral vasospasm following aneurysm rupture: Outcomes and predictors in 116 patients

Endovascular treatment for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: predictors of outcome and retreatment

“…The rate of functional independence is lower and the mortality rate is higher compared with the literature 23. In a recent retrospective study of 116 patients who underwent endovascular treatment for vasospasm, Chalouhi et al reported good functional outcome (Glasgow Outcome Scale (GOS) 4–5) in 73% of patients, with comparable mean age to our study, at discharge 24. Of note, 9.5% of patients in this study had non-aneurysmal SAH, and microsurgical clipping was performed in a lower proportion of patients (27.6%) compared with our cohort.…”

“…In contrast, Chalouhi et al reported higher HH grades, pre-procedural hypodensities, posterior circulation aneurysm location, and lack of neurological improvement (p<0.001) following treatment to be significant predictors of poor outcome at discharge 24. In another study of 81 patients with aSAH with symptomatic vasospasm who underwent endovascular treatment, Rabinstein et al found older age (p=0.02) and higher WFNS grade (p=0.02) to be predictors of poor outcome (mRS 3–6) at a median follow-up of 3 months 26.…”

“…Older age (p=0.004), symptomatic vasospasm (p=0.046), initial vasospasm treatment with angioplasty alone (p=0.039), and combined initial treatment with IA vasodilator infusion and angioplasty (p=0.026) were negative independent predictors of retreatment. In comparison, Chalouhi et al observed that higher HH grades and treatment with nicardipine alone or angioplasty with nicardipine were independent positive predictors of retreatment 24. Jun et al reported higher rates of retreatment in patients treated with verapamil alone (51%) compared with those treated with angioplasty and verapamil (17%) or angioplasty alone (0%) 25.…”

Brief serotonin exposure initiates arteriolar inward remodeling processes in vivo that involve transglutaminase activation and actin cytoskeleton reorganization

“…Although our studies were performed in vessels from skeletal muscle, it has been demonstrated in rat middle cerebral arteries that 5-HT increases the phosphorylation state of cofilin and reduces the concentration of G-actin, indicating that 5-HT-induced remodeling of the actin cytoskeleton also occurs in the cerebral circulation (36), where localized vasoconstriction or vasospasm following subarachnoid hemorrhage or hemorrhagic stroke hinders blood flow re-establishment (8,12,39). Moreover, in a rat model of subarachnoid hemorrhage, inward remodeling of middle cerebral arteries, following exposure to hemolyzed blood, is blocked by inhibition of transglutaminases (17).…”

Institution of sustained endovascular treatment prior to clinical deterioration in patients with severe angiographic vasospasm: A retrospective observational study of clinico-radiological outcomes

“…Retrospective analyses at hospital and nationwide levels have suggested that institutions that offer endovascular treatment for vasospasm may have lower rates of unfavourable outcome [39,40]. However, the decision to treat, timing and number of treatments is crucial and this study differs from others [41][42][43] in the approach. DSA was used to screen.…”