Predictive factors for improvement of symptomatic cerebral vasospasm following subarachnoid hemorrhage by selective intra-arterial administration of fasudil hydrochloride

Abstract

Background Symptomatic cerebral vasospasm after subarachnoid hemorrhage (SAH) is a significant cause of delayed cerebral ischemia that leads to poor outcomes. Selective intra-arterial administration of fasudil hydrochloride (IAF) has been adopted for its vasodilatory effect on spasm arteries to prevent delayed cerebral ischemia. However, its effect on clinical outcomes and predictive factors for good recovery are not fully understood. This study aimed to investigate the outcomes of selective IAF and identify predictive factors for good outcomes in patients with cerebral vasospasm after SAH. Methods A retrospective study of 36 patients with cerebral vasospasm following SAH who underwent selective IAF at our institution between January 2014 and May 2022 was conducted. We evaluated the improvements in neurological findings before and after selective IAF. Statistical analyses were performed to determine factors associated with good outcomes. Results Selective IAF improved the neurological findings in 26 patients (72.2%). Pre-therapeutic absence of cerebral infarction in more than 1/3 of the spasm artery perfusion area was significantly associated with an improvement in neurological findings ( p < 0.0001). Furthermore, there was a tendency for a good outcome when the age was younger ( p = 0.093), and the spasm was limited to peripheral vessels ( p = 0.065). Conclusion Our study indicates that selective IAF has a promising effect in improving symptomatic vasospasm, except when a large cerebral infarction exists in the spasm artery perfusion area. Early consideration of selective IAF could be recommended once patients experience symptomatic cerebral vasospasm after SAH.

Factors Influencing Discontinuation of Clazosentan Therapy in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study from a Japanese Single Center

“…If the maximal systolic blood pressure was >180 mmHg, a calcium antagonist was administered. For adverse cardiopulmonary events nonresponsive to standard medical care within 48 hours, clazosentan was discontinued and switched further to rescue therapy, including dobutamine-induced hyperdynamic and/or endovascular therapy (intraarterial fasudil and/or percutaneous transluminal balloon angioplasty) [ 15 , 16 ], until symptom resolution.…”

Prevention and treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage

“…Data for other IA vasodilators are largely retrospective. IA verapamil [72] and fasudil [73] have neurologic response rates around 70% in retrospective studies.…”

Diagnosis and treatment of cerebral vasospasm after subarachnoid hemorrhage

“…In a retrospective cohort study involving 45 patients receiving oral nimodipine and fasudil versus 32 patients receiving nimodipine, the observation group displayed a significantly higher response rate than the control group: average cerebral blood flow velocities of the anterior, posterior, and middle cerebral arteries were decreased, cognitive function recovery by Montreal Cognitive Assessment Scale (MOCA) scores were increased, and activities of daily living were improved [67]. Evidence for selective use of IT fasudil is being proposed, specifically when the vasospastic territory is located primarily in distal vessels and occurs in younger patients [68].…”