Neurosurg Focus
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The second leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (SAH) is delayed cerebral ischemia due to vasospasm. Although up to 70% of patients have been shown to have angiographic evidence of vasospasm, only 20-30% will present with clinical changes, including mental status changes and neurological deficits that necessitate acute management. ⋯ The rationale for intraarterial therapy includes the fact that morbidity and mortality rates have not changed in recent years despite optimized noninvasive medical care. In this report, the authors discuss the most common endovascular options-namely intraarterial vasodilators and transluminal balloon angioplasty-from the standpoint of mechanism, efficacy, limitations, and complications as well as the treatment algorithms for cerebral vasospasm used at our institution.
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Endovascular cerebral revascularization is becoming a frequently used alternative to surgery for the treatment of atherosclerotic disease, especially in the intracranial circulation where options are limited. Recent literature regarding the equivalent efficacy of carotid artery stenting and carotid endarterectomy in certain patient populations, as well as the recognition of the significant risk for recurrent stroke posed by intracranial lesions, will only serve to amplify this trend. Hyperperfusion syndrome has been well documented in the setting of carotid endarterectomy; however, a paucity of literature exists regarding the incidence, pathophysiology, and management as it relates to percutaneous interventions. The purpose of this review is to outline the current state of knowledge, with particular attention to the distinct attributes of endovascular treatment that would be expected to modify the course of hyperperfusion syndrome.