Endovascular Rescue Treatment for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Is Safe and Effective
Background: The implementation of rescue efforts for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage remains largely empirical for a lack of supporting evidence, while the associated risk profile is also unclear.Objective: The present study evaluates the safety and efficacy of end...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.00136/full |
| _version_ | 1819085448980463616 |
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| author | Miriam Weiss Catharina Conzen Marguerite Mueller Martin Wiesmann Hans Clusmann Walid Albanna Gerrit Alexander Schubert |
| author_facet | Miriam Weiss Catharina Conzen Marguerite Mueller Martin Wiesmann Hans Clusmann Walid Albanna Gerrit Alexander Schubert |
| author_sort | Miriam Weiss |
| collection | DOAJ |
| description | Background: The implementation of rescue efforts for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage remains largely empirical for a lack of supporting evidence, while the associated risk profile is also unclear.Objective: The present study evaluates the safety and efficacy of endovascular rescue treatment (ERT, continuous intraarterial nimodipine; IAN, transcutaneous balloon angioplasty, TBA).Methods: In this prospective observational study, we assessed periprocedural complications and side effects in context of ERT. We evaluated neurological status, multimodal neuromonitoring (ptiO2, lactate/pyruvate ratio, transcranial doppler), and cranial imaging (CTP, DSA). All parameters were included into multivariate analysis to determine predictors for the need of retreatment.Results: We included 33 consecutive patients with 54 ERT (IAN n = 35; TBA n = 13; TBA + IAN n = 6). We recorded no serious complications and initial improvement in all parameters (neurostatus 72.3% of patients; ptiO2 15.0 ± 11.7 to 25.8 ± 15.5 mmHg, p < 0.0001; lactate/pyruvate ratio 46.3 ± 27.5 to 31.0 ± 9.7, p <0.05; transcranial doppler 139.0 ± 46.3 to 98.9 ± 29.6 cm/s, p < 0.05; CTP 81.6% of patients; DSA 93.1% of patients). Retreatment (n = 16, 48.5%) was independently associated with preinterventional ptiO2 < 5 mmHg (p <0.01) and early (<72 h) discontinuation of IAN treatment (p = 0.08). DCI related cerebral infarction was noted in n = 8 patients (24.2%). At 3 months after discharge, favorable outcome was noted for n = 11 (35.5%) patients.Conclusion: Provided a detailed decision tree, timely ERT can provide a relatively safe and effective treatment option in those highly-selected patients undergoing multimodality monitoring where conservative treatment options are exhausted. Continuous treatment in particular may be suitable to surpass sustained DCI and was associated with a low rate of DCI related infarction and comparably high percentage of good outcome. |
| first_indexed | 2024-12-21T21:04:32Z |
| format | Article |
| id | doaj.art-d9b3ee27a12844d1963df73fe1a03afd |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-21T21:04:32Z |
| publishDate | 2019-02-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-d9b3ee27a12844d1963df73fe1a03afd2022-12-21T18:50:21ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-02-011010.3389/fneur.2019.00136423461Endovascular Rescue Treatment for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Is Safe and EffectiveMiriam Weiss0Catharina Conzen1Marguerite Mueller2Martin Wiesmann3Hans Clusmann4Walid Albanna5Gerrit Alexander Schubert6Department of Neurosurgery, RWTH Aachen University, Aachen, GermanyDepartment of Neurosurgery, RWTH Aachen University, Aachen, GermanyDepartment of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, GermanyDepartment of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, GermanyDepartment of Neurosurgery, RWTH Aachen University, Aachen, GermanyDepartment of Neurosurgery, RWTH Aachen University, Aachen, GermanyDepartment of Neurosurgery, RWTH Aachen University, Aachen, GermanyBackground: The implementation of rescue efforts for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage remains largely empirical for a lack of supporting evidence, while the associated risk profile is also unclear.Objective: The present study evaluates the safety and efficacy of endovascular rescue treatment (ERT, continuous intraarterial nimodipine; IAN, transcutaneous balloon angioplasty, TBA).Methods: In this prospective observational study, we assessed periprocedural complications and side effects in context of ERT. We evaluated neurological status, multimodal neuromonitoring (ptiO2, lactate/pyruvate ratio, transcranial doppler), and cranial imaging (CTP, DSA). All parameters were included into multivariate analysis to determine predictors for the need of retreatment.Results: We included 33 consecutive patients with 54 ERT (IAN n = 35; TBA n = 13; TBA + IAN n = 6). We recorded no serious complications and initial improvement in all parameters (neurostatus 72.3% of patients; ptiO2 15.0 ± 11.7 to 25.8 ± 15.5 mmHg, p < 0.0001; lactate/pyruvate ratio 46.3 ± 27.5 to 31.0 ± 9.7, p <0.05; transcranial doppler 139.0 ± 46.3 to 98.9 ± 29.6 cm/s, p < 0.05; CTP 81.6% of patients; DSA 93.1% of patients). Retreatment (n = 16, 48.5%) was independently associated with preinterventional ptiO2 < 5 mmHg (p <0.01) and early (<72 h) discontinuation of IAN treatment (p = 0.08). DCI related cerebral infarction was noted in n = 8 patients (24.2%). At 3 months after discharge, favorable outcome was noted for n = 11 (35.5%) patients.Conclusion: Provided a detailed decision tree, timely ERT can provide a relatively safe and effective treatment option in those highly-selected patients undergoing multimodality monitoring where conservative treatment options are exhausted. Continuous treatment in particular may be suitable to surpass sustained DCI and was associated with a low rate of DCI related infarction and comparably high percentage of good outcome.https://www.frontiersin.org/article/10.3389/fneur.2019.00136/fullangioplastydelayed cerebral ischemiaendovascular rescue treatmentneuromonitoringnimodipinespasmolysis |
| spellingShingle | Miriam Weiss Catharina Conzen Marguerite Mueller Martin Wiesmann Hans Clusmann Walid Albanna Gerrit Alexander Schubert Endovascular Rescue Treatment for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Is Safe and Effective Frontiers in Neurology angioplasty delayed cerebral ischemia endovascular rescue treatment neuromonitoring nimodipine spasmolysis |
| title | Endovascular Rescue Treatment for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Is Safe and Effective |
| title_full | Endovascular Rescue Treatment for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Is Safe and Effective |
| title_fullStr | Endovascular Rescue Treatment for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Is Safe and Effective |
| title_full_unstemmed | Endovascular Rescue Treatment for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Is Safe and Effective |
| title_short | Endovascular Rescue Treatment for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Is Safe and Effective |
| title_sort | endovascular rescue treatment for delayed cerebral ischemia after subarachnoid hemorrhage is safe and effective |
| topic | angioplasty delayed cerebral ischemia endovascular rescue treatment neuromonitoring nimodipine spasmolysis |
| url | https://www.frontiersin.org/article/10.3389/fneur.2019.00136/full |
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