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Neurologia Medico-chirurgica 2015Mechanically-induced vasospasm often occurs during guiding catheter insertion, occasionally preventing catheter advancement to the desired location. Delicate...
Mechanically-induced vasospasm often occurs during guiding catheter insertion, occasionally preventing catheter advancement to the desired location. Delicate manipulation would be impossible without the proper positioning of guiding catheters, and vasospasm-induced cerebral hypoperfusion may cause thrombotic complications. From June 2012 to December 2013, we prospectively analyzed 150 endovascular treatment cases, excluding acute cases, for the frequency of vasospasm, risk factors, and countermeasures. The associated risk factors such as the Japanese-style State-Trait Anxiety Inventory (STAI) score; anatomy and devices; and the efficacies of warm compresses, intra-arterial lidocaine/nicardipine, and tranquilizers were analyzed. Groups 1, 2, and 3 comprised 50 patients each with controls, tranquilizer administration, and prophylactic warm compresses/intra-arterial drug injection, respectively. Moderate or severe vasospasm was seen in approximately 40% patients in each group; however, severe vasospasm was absent in Group 3. Mild vasospasm-induced cerebral infarction occurred in one patient each in Groups 1 and 2. Vasospasm during diagnostic angiography [odds ratio (OR) = 10.63; P = 0.01], many ≥ 30° vessel curves [OR = 4.21; P = 0.01], and the high STAI score [OR = 1.84; P = 0.01] were risk factors for severe vasospasm. Although the relationship between anxiety and sympathetic tone remained unclear, tranquilizer administration relieved vasospasm. Warm compresses and the intra-arterial drug infusion were also useful for relieving vasospasm. Prophylactic measures such as a tranquilizer and warm compresses are expected to alleviate vasospasm; in addition, countermeasures such as the intra-arterial injection of lidocaine/nicardipine are effective.
Topics: Catheterization; Endovascular Procedures; Female; Humans; Intraoperative Complications; Male; Middle Aged; Prospective Studies; Risk Factors; Vasospasm, Intracranial
PubMed: 25739431
DOI: 10.2176/nmc.oa.2014-0268 -
Archives of Medical Sciences.... 2020The vasospasm of carotid arteries is important for the progression of neurological sequelae. Many mechanisms have been found to be related to this clinical phenomenon....
INTRODUCTION
The vasospasm of carotid arteries is important for the progression of neurological sequelae. Many mechanisms have been found to be related to this clinical phenomenon. Predicting this event by using hematological biomarkers may provide opportunities for adopting preventive measures against unfavorable neurovascular complications. The aim of this study is to determine the hematological predictors of carotid artery vasospasm during carotid stenting.
MATERIAL AND METHODS
A total of 120 patients who underwent carotid stenting were divided into two groups: those with and without carotid artery vasospasm. Carotid artery vasospasm was angiographically defined as transient or persistent emergent stenosis or irregularity of the vessel wall without evidence of thrombosis during carotid stenting. The hematological parameters were compared between 21 patients who developed carotid artery vasospasm (17.5%) and 99 patients who did not (82.5%).
RESULTS
The mean age of the patients with carotid artery vasospasm and without carotid artery vasospasm was 66 ±8 and 70 ±8 years, respectively. Creatinine levels within 0.5-0.9 (OR = 3.704, 95% CI: 1.245-11.019, = 0.019), each 1000 unit increase in neutrophil count (OR = 1.567, 95% CI: 1.027-2.392, = 0.037) and presence of diabetes (OR = 3.081, 95% CI: 1.116-8.505, = 0.030) were the independent predictors of carotid artery vasospasm in carotid arteries during carotid stenting.
CONCLUSIONS
The prediction of carotid artery vasospasm during carotid stenting should help clinicians adopt preventive measures against the development of neurological sequelae. This study found that creatinine levels, increased neutrophil count and presence of diabetes are independent predictors of carotid artery vasospasm.
PubMed: 32832722
DOI: 10.5114/amsad.2020.97722 -
Neurocritical Care Sep 2011Ischemia is a common cause of secondary neuronal injury after aneurysmal subarachnoid hemorrhage. An electronic literature search was conducted to identify clinical...
Ischemia is a common cause of secondary neuronal injury after aneurysmal subarachnoid hemorrhage. An electronic literature search was conducted to identify clinical signs and laboratory data that could serve as predictors for delayed cerebral ischemia and define triggers for additional diagnostic testing or more aggressive intervention. Fifteen articles describing original research that included some discussion of triggers were identified and reviewed. Quality of evidence was considered very low to moderate for included studies. Using data from these studies and expert opinion, a variety of clinical signs and monitoring data were identified as potentially useful triggers for additional tests or aggressive treatments. These data were used to develop a sequence that might be employed in the clinical management of subarachnoid hemorrhage to determine which patients need additional attention, testing, or interventions to reduce/prevent ischemia caused by vasospasm.
Topics: Acute Disease; Critical Care; Humans; Predictive Value of Tests; Risk Factors; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 21748498
DOI: 10.1007/s12028-011-9597-5 -
Circulation Journal : Official Journal... Aug 2022
Topics: Coronary Angiography; Coronary Vasospasm; Coronary Vessel Anomalies; Humans
PubMed: 35342126
DOI: 10.1253/circj.CJ-22-0083 -
Neurotherapeutics : the Journal of the... Jan 2012Cerebral vasospasm occurs frequently after aneurysmal subarachnoid and contributes to delayed cerebral ischemia. In this article we address systematic problems with the... (Review)
Review
Cerebral vasospasm occurs frequently after aneurysmal subarachnoid and contributes to delayed cerebral ischemia. In this article we address systematic problems with the literature on vasospasm and then review both established and experimental treatment options.
Topics: Choice Behavior; Humans; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 22215324
DOI: 10.1007/s13311-011-0098-1 -
Neurosurgery May 2013Delayed cerebral ischemia is common after aneurysmal subarachnoid hemorrhage (aSAH) and is a major contributor to poor outcome. Yet, although generally attributed to...
BACKGROUND
Delayed cerebral ischemia is common after aneurysmal subarachnoid hemorrhage (aSAH) and is a major contributor to poor outcome. Yet, although generally attributed to arterial vasospasm, neurological deterioration may also occur in the absence of vasospasm.
OBJECTIVE
To determine the relationship between delayed infarction and angiographic vasospasm and compare the characteristics of infarcts related to vasospasm vs those unrelated.
METHODS
A retrospective review of patients with aSAH admitted from July 2007 through June 2011. Patients were included if they were admitted within 48 hours of SAH, had a computed tomography scan both 24 to 48 hours following aneurysm treatment and ≥7 days after SAH, and had a catheter angiogram to evaluate for vasospasm. Delayed infarcts seen on late computed tomography but not postprocedurally were attributed to vasospasm if there was moderate or severe vasospasm in the corresponding vascular territory on angiography. Infarct volume was measured by perimeter tracing.
RESULTS
Of 276 aSAH survivors, 134 had all imaging requisite for inclusion. Fifty-four (34%) had moderate or severe vasospasm, of whom 17 (31%) had delayed infarcts, compared with only 3 (4%) of 80 patients without vasospasm (P < .001). There were a total of 29 delayed infarcts in these 20 patients; 21 were in a territory with angiographic vasospasm, but 8 (28%) were not. Infarct volume did not differ between vasospasm-related (18 ± 25 mL) and vasospasm-unrelated (11 ± 12 mL) infarcts (P = .54), but infarcts in the absence of vasospasm were more likely watershed (50% vs. 10%, P = .03).
CONCLUSION
Delayed infarcts following aSAH can occur in territories without angiographic vasospasm and are more likely watershed in distribution.
Topics: Angiography, Digital Subtraction; Cerebral Infarction; Comorbidity; Female; Humans; Incidence; Male; Middle Aged; Missouri; Risk Assessment; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 23313984
DOI: 10.1227/NEU.0b013e318285c3db -
Stroke Jul 2012Angiographic vasospasm frequently complicates subarachnoid hemorrhage and has been implicated in the development of delayed cerebral ischemia. Whether large-vessel...
BACKGROUND AND PURPOSE
Angiographic vasospasm frequently complicates subarachnoid hemorrhage and has been implicated in the development of delayed cerebral ischemia. Whether large-vessel narrowing adequately accounts for the critical reductions in regional cerebral blood flow underlying ischemia is unclear. We sought to clarify the relationship between angiographic vasospasm and regional hypoperfusion.
METHODS
Twenty-five patients with aneurysmal subarachnoid hemorrhage underwent cerebral catheter angiography and 15O-positron emission tomographic imaging within 1 day of each other (median of 7 days after subarachnoid hemorrhage). Severity of vasospasm was assessed in each intracranial artery, whereas cerebral blood flow and oxygen extraction fraction were measured in 28 brain regions distributed across these vascular territories. We analyzed the association between vasospasm and perfusion and compared frequency of hypoperfusion (cerebral blood flow<25 mL/100 g/min) and oligemia (low oxygen delivery with oxygen extraction fraction≥0.5) in territories with versus without significant vasospasm.
RESULTS
Twenty-four percent of 652 brain regions were supplied by vessels with significant vasospasm. Cerebral blood flow was lower in such regions (38.6±12 versus 48.7±16 mL/100 g/min), whereas oxygen extraction fraction was higher (0.48±0.19 versus 0.37±0.14, both P<0.001). Hypoperfusion was seen in 46 regions (7%), but 66% of these were supplied by vessels with no significant vasospasm; 24% occurred in patients without angiographic vasospasm. Similarly, oligemia occurred more frequently outside territories with vasospasm.
CONCLUSIONS
Angiographic vasospasm is associated with reductions in cerebral perfusion. However, regional hypoperfusion and oligemia frequently occurred in territories and patients without vasospasm. Other factors in addition to large-vessel narrowing must contribute to critical reductions in perfusion.
Topics: Aged; Blood Flow Velocity; Cerebral Angiography; Cerebrovascular Circulation; Female; Humans; Male; Middle Aged; Positron-Emission Tomography; Retrospective Studies; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 22492520
DOI: 10.1161/STROKEAHA.111.646836 -
Aging Feb 2020We explored whether acute atorvastatin treatment would improve clinical outcomes and reduce the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage... (Randomized Controlled Trial)
Randomized Controlled Trial
We explored whether acute atorvastatin treatment would improve clinical outcomes and reduce the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage in elderly Chinese adults. Patients (60 to 90 years old) were admitted to intensive care units after surgery to clip or embolize their aneurysms. We assessed 592 patients and assigned 159 to receive atorvastatin (20 mg/day) and 158 to receive placebo once daily for up to 14 days. The primary outcome was the Glasgow outcome scale at 6 months, and secondary outcomes were cerebral vasospasm, 30-days all-cause mortality, cerebral infarction, and delayed ischemic neurological deficit. The incidence of postoperative cerebral vasospasm (39.3% vs 56%, =0.004) and cerebral infarction (18.7% vs 27.3%, =0.027) were significantly lower in the atorvastatin group. The study did not detect benefits in the use of atorvastatin for 6 months clinical outcome or 30-day all-cause mortality, but it suggests that atorvastatin together with nimodipine can reduce cerebral vasospasm and cerebral infarction after subarachnoid hemorrhage.
Topics: Aged; Aged, 80 and over; Atorvastatin; Cerebral Infarction; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Subarachnoid Hemorrhage; Vasospasm, Intracranial
PubMed: 32035420
DOI: 10.18632/aging.102788 -
Journal of Neurology Oct 2022Aneurysm treatment during cerebral vasospasm (CVS) phase is frequently considered as particularly dangerous, mainly because of the risk of cerebral infarct.
BACKGROUND
Aneurysm treatment during cerebral vasospasm (CVS) phase is frequently considered as particularly dangerous, mainly because of the risk of cerebral infarct.
OBJECTIVE
We aimed to evaluate the risk of aneurysmal subarachnoid haemorrhage (aSAH)-specific complications and functional outcome in patients treated during CVS phase.
METHODS
We retrospectively analysed a large, retro- and prospectively collected database of aSAH patients admitted to our department between March 2006 and March 2020. We conducted a uni- and multivariable logistic regression analysis to evaluate influencing factors on rebleeding, cerebral infarct, Glasgow Outcome Score (GOS) at discharge and mortality and assessed the rate of angiographic vasospasm on admission.
RESULTS
We included 853 patients. The majority of patients were female (66.6%), mean age was 57.3 years. Out of 853 included patients, 92 (10.8%) were treated during CVS phase, 312 (36.6%) underwent clipping and 541 (63.4%) endovascular treatment. Treatment during CVS phase was significantly associated with cerebral infarct in the multivariable logistic regression analysis, unrelated to the nature of intervention (OR 2.42, 1.29-4.54 95% CI p-value = 0.006). However, patients treated during CVS phase did not have increased risk of unfavourable outcome by GOS on discharge. In addition, they did not have a higher rate of rebleeding or mortality.
CONCLUSIONS
Treatment during CVS phase was significantly associated with a higher rate of cerebral infarct as confirmed by imaging. This did not reflect on GOS on discharge, rebleeding, or mortality. Aneurysm treatment during CVS phase is relatively safe and should not be postponed due to the risk of rebleeding and subsequent devastating deterioration.
Topics: Angiography; Cerebral Infarction; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Retrospective Studies; Subarachnoid Hemorrhage; Treatment Outcome; Vasospasm, Intracranial
PubMed: 35729347
DOI: 10.1007/s00415-022-11212-w -
Cureus Mar 2022Introduction Vasospasm is a significant cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to...
Introduction Vasospasm is a significant cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to evaluate a possible link between vasospasm in patients with aneurysmal SAH and magnesium and blood pressure levels. Methods Subjects were selected based on chart review of patients presenting to a comprehensive stroke center in Southern California with aneurysmal SAH. 27 were included based on the following criteria: patients greater than 18 years of age, aneurysmal SAH, clinically symptomatic vasospasms and at least one diagnostic confirmation - either from a transcranial doppler (TCD) or digital subtraction angiogram (DSA). The following exclusion criteria also applied: 1) incomplete documentation in the medical record; 2) patients <18 years of age; and 3) patients without TCD measurements. Results In an overall analysis of all patients with or without vasospasm, it was found that the presence of vasospasm was significantly correlated with diastolic blood pressures (DBPs) on day of vasospasm with an r value of 0.418 and p<0.001. Average daily DBPs throughout hospital stay were also correlated with vasospasm with an r-value of 0.455 and p<0.001. Changes in magnesium overall were also significantly related to left Lindegaard ratios with an r value of -0.201 and p value of 0.032. Lindegaard ratios were significantly correlated with age with r values of 0.510, p<0.001, and r=-0.482, p<0.001 for left and right, respectively. A change in magnesium was inversely correlated to the left Lindegaard ratio with an n of 31 and p value of 0.014 (r= -0.439) in patients with vasospasm. We also found a lower incidence of vasospasm in patients older than 65. Conclusion Monitoring magnesium and increases in DBP might be effective as a prophylactic adjunct method in patients with SAH in an effort to predict clinical vasospasm.
PubMed: 35444882
DOI: 10.7759/cureus.23161