Intra-Arterial Papaverine-Hydrochloride and Transluminal Balloon Angioplasty for Neurointerventional Management of Delayed-Onset Post-Aneurysmal Subarachnoid Hemorrhage Vasospasm

Hosmann, Arthur; Rauscher, Steffen; Wang, Wei-Te; Dodier, Philippe; Bavinzski, Gerhard; Knosp, Engelbert; Gruber, Andreas

doi:10.1016/j.wneu.2018.07.138

Cited by 21 publications

(17 citation statements)

References 35 publications

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“…reported that a key factor contributing to the discrepancy between angiographic improvement and outcome is delayed diagnosis of impending ischemia, and considered the ideal timing of endovascular procedures needed to prevent CI. [ 7 ] We therefore speculated that previous reports were unable to prove good clinical outcomes after ET for CV despite angiographic improvement. In the present study, the indication of ET was adopted for symptomatic cases and asymptomatic cases with vessel narrowing ≥50% compared to initial CTA based on previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies about ET for CV in aSAH patients, the decision-making process for treatment has mostly involved angiographic observation and clinical deterioration, indicative of DCI, not evaluation of cerebral perfusion. [ 7 , 20 ] Many studies did not consider cerebral perfusion. To improve outcomes, selection of patients based on cerebral perfusion may be needed for CV after SAH.…”

Section: Discussionmentioning

confidence: 99%

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Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

Omoto¹,

Nakagawa²,

Nishimura³

et al. 2020

Surgical Neurology International

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Background: Endovascular treatment (ET) can improve angiographic cerebral vasospasm (CV) after aneurysmal subarachnoid hemorrhage, but was unrelated to clinical outcomes in previous analyses. Appropriate detection of CV and precise indications for ET are required. This study investigated whether changes in computed tomography perfusion (CTP) parameter can determine indications for ET in CV and predict its effectiveness. Methods: Participants comprised 140 patients who underwent neck clipping or coil embolization. CTP was performed a week after aneurysmal treatment or when clinical deterioration had occurred. Patients were divided into ET and non-ET groups by propensity score matching. In addition, the ET group was divided into subgroups with and without new cerebral infarction (CI). All CTP images in the three groups were retrospectively investigated qualitatively and quantitatively. CI was diagnosed from CT at 3 months postoperatively. Results: Of the 121 patients examined, 15 patients (11%) needed ET. In qualitative analysis, all ET group patients displayed extension of time-to-peak (TTP) at the region of vasospastic change, regardless of the presence of CI. Quantitative analysis showed significant decreases in cerebral blood volume (P < 0.01), cerebral blood flow (CBF) (P < 0.001), and extension in TTP (P < 0.01) in the ET group compared with the non-ET group. A significant decrease in CBF (P < 0.001) and extension in mean transit time (P < 0.001) was seen in the ET with CI subgroup compared with the ET without CI subgroup. Conclusion: CTP in the vasospastic period may be an indication for ET and predict the effectiveness of ET for CV to improve clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

Omoto¹,

Nakagawa²,

Nishimura³

et al. 2020

Surgical Neurology International

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“…Intraarterial papaverine (IAP) is a strong vasodilator that reduces angiographic vasospasm following an aSAH in most cases. However, owing to its short half-life, IAP has only a transient effect with the risk of recurrent or persistent vasospasm, necessitating repeated interventions 37 . In addition, the use of papaverine proved to have other limitations, including some adverse effects such an increase in intracranial pressure (ICP), worsening of vasospasm, brain stem depression, seizures, and transient focal neurological deficit 38,39 .…”

Section: Treatmentmentioning

confidence: 99%

Vasospasm after transsphenoidal adenoma removal: risk factors and new treatment perspectives for this rare event.

et al. 2021

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Cerebral vasospasm is an uncommon complication following transsphenoidal surgery (TSS) of a pituitary adenoma. Therefore, neither its physiopathology nor its management are clear. We present a case of vasospasm after TSS and we discuss about its etiology and treatment. A 52-year-old woman presented with hirsutism, without neurologic symptoms. A MRI showed a pituitary macroadenoma. The patient underwent an endoscopic transsphenoidal approach. Post-operative CT scan revealed an extensive subarachnoid haemorrhage (SAH). On postoperative 7th day, she developed an abrupt mixed aphasia. An urgent arteriography showed left middle cerebral artery vasospasm, so intra-arterial nimodipine was administered. After that, vasospasm disappeared and the patient recovered completely. The key to successful management of this rare complication is a high index of suspicion. The presence of postoperative SAH seems to definitely contribute to its apparition. Therefore, treatment in concordance with protocols for vasospasm due to aneurysmal SAH is recommended.

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“…Poor patients' outcome after aSAH is owed a multifactorial process (early brain injury, DCVS, DCI, cerebral inflammation, cortical spreading depression, loss of pressure dependent cerebral autoregulation) [4,5,7,9,[110][111][112][113]. DCVS is treated with moderate hypertensive, normovolemic, hemodilution, and in cases of therapy-refractory, DCVS with intra-arterial spasmolysis or balloon dilatation [114,115]. Research to improve poor functional outcome in patients suffering from aSAH and related DCVS is pivotal [1,5,21,116,117].…”

Section: Therapeutic Interventions After Asahmentioning

confidence: 99%

The Role of Sartans in the Treatment of Stroke and Subarachnoid Hemorrhage: A Narrative Review of Preclinical and Clinical Studies

et al. 2020

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Background: Delayed cerebral vasospasm (DCVS) due to aneurysmal subarachnoid hemorrhage (aSAH) and its sequela, delayed cerebral ischemia (DCI), are associated with poor functional outcome. Endothelin-1 (ET-1) is known to play a major role in mediating cerebral vasoconstriction. Angiotensin-II-type-1-receptor antagonists such as Sartans may have a beneficial effect after aSAH by reducing DCVS due to crosstalk with the endothelin system. In this review, we discuss the role of Sartans in the treatment of stroke and their potential impact in aSAH. Methods:We conducted a literature research of the MEDLINE PubMed database in accordance with PRISMA criteria on articles published between 1980 to 2019 reviewing: "Sartans AND ischemic stroke". Of 227 studies, 64 preclinical and 19 clinical trials fulfilled the eligibility criteria. Results: There was a positive effect of Sartans on ischemic stroke in both preclinical and clinical settings (attenuating ischemic brain damage, reducing cerebral inflammation and infarct size, increasing cerebral blood flow). In addition, Sartans reduced DCVS after aSAH in animal models by diminishing the effect of ET-1 mediated vasoconstriction (including cerebral inflammation and cerebral epileptogenic activity reduction, cerebral blood flow autoregulation restoration as well as pressure-dependent cerebral vasoconstriction). Conclusion: Thus, Sartans might play a key role in the treatment of patients with aSAH.Multiple studies showed that endothelin-1 (ET-1), a most potent vasoconstrictor [9][10][11], plays a key role in the development of DCVS [12][13][14][15][16][17][18][19]. Although endothelin-A-receptor (ET A -R) antagonists in the treatment of DCVS in animal models are effective [10,20], clinical studies did not show beneficial effects [21,22]. It has been reported that the polypeptide angiotensin-II acts through two specific receptors, in essence the angiotensin-II-type-1-and angiotensin-II-type-2-receptor (AT 2 -1-R and AT 2 -2-R). Important to note is that activation of the AT 2 -1-R results in vasoconstriction while binding of angiotensin-II to the AT 2 -2-R causes vasorelaxation [23]. In line with this notion, preclinical as well as clinical trials showed promising results of Sartans, which are AT 2 -1-R antagonists, in ischemic stroke. Hence, Sartans may have a positive effect after aSAH by reducing DCVS due to crosstalk with the endothelin system. Thus, we aimed to analyze the potential role of Sartans in the treatment of aSAH. Materials and MethodsWe conducted a systematic literature research of the MEDLINE PubMed database in accordance with PRISMA guidelines on preclinical studies on the one and on clinical studies on the other hand published between 1980 to 2019 reviewing: "Sartans and ischemic stroke" [24]. Only articles in English were chosen for review. Search items with "Sartans" (n = 19,064) and "ischemic stroke" (n = 89,465) were extracted. For "Sartans AND ischemic stroke", 227 publications met the inclusion criteria by excluding studies with commentary only, any dupli...

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Intra-Arterial Papaverine-Hydrochloride and Transluminal Balloon Angioplasty for Neurointerventional Management of Delayed-Onset Post-Aneurysmal Subarachnoid Hemorrhage Vasospasm

Cited by 21 publications

References 35 publications

Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

Vasospasm after transsphenoidal adenoma removal: risk factors and new treatment perspectives for this rare event.

The Role of Sartans in the Treatment of Stroke and Subarachnoid Hemorrhage: A Narrative Review of Preclinical and Clinical Studies

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