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angiographic_vasospasm

Angiographic vasospasm

Usually develops between 5 and 15 days after the initial hemorrhage, and is associated with clinically apparent delayed ischemic neurological deficits (DID) in one-third of patients.

Pathophysiology

Is not fully understood but appears to involve structural changes and biochemical alterations at the levels of the vascular endothelium and smooth muscle cells. Blood in the subarachnoid space is believed to trigger these changes. In addition, cerebral perfusion may be concurrently impaired by hypovolemia and impaired cerebral autoregulatory function. The combined effects of these processes can lead to reduction in cerebral blood flow so severe as to cause ischemia leading to infarction.

Treatment

The strategy to treat asymptomatic angiographic cerebral vasospasm following subarachnoid hemorrhage (SAH) is controversial.

Shimamura et. al, treated 281 aneurysmal SAH cases, with postoperative angiography performed 9 ± 2 days after the onset of SAH. Four asymptomatic cases received intra-arterial (IA) injection of vasodilator due to angiographic vasospasm. All cases improved vasospasm immediately following intervention. But all cases turned symptomatic within 48 hours.

We retrospectively analyzed the time-density angiography curve and calculated the time to peak (TTP), mean transit time (MTT), and relative blood flow (rBF). Relative blood flow was calculated as follows. The integration of the value of the time-density curve for the artery was divided by the same value for the internal carotid artery multiplied by the MTT.

The decrease in TTP and MTT for the etiologic artery was similar to that of the nonetiologic artery. But the improvement in rBF for the etiologic artery and nonetiologic artery was 10% and 17%, respectively. Blood supply to the spastic artery decreased due to iatrogenic steal.

Prophylactic IA injection of vasodilator in cases of asymptomatic vasospasm can produce symptomatic vasospasm 1).

1)
Shimamura N, Naraoka M, Matsuda N, Kakuta K, Ohkuma H. Prophylactic Intra-Arterial Injection of Vasodilator for Asymptomatic Vasospasm Converts the Patient to Symptomatic Vasospasm due to Severe Microcirculatory Imbalance. Biomed Res Int. 2014;2014:382484. doi: 10.1155/2014/382484. Epub 2014 Apr 16. PubMed PMID: 24822199.
angiographic_vasospasm.txt · Last modified: 2014/10/17 18:23 (external edit)