SAH Vasospasm Endovascular Treatment

Authors: Dr Peter Mitchell*
                            Dr Winston Chong *

What are the prerequisites for having a SAH Vasospasm Endovascular Treatment done?

Consultation with the treating specialist (neurosurgeon or neurointerventionist) followed by referral to the neurointerventionist. The aim is early detection, as the likelihood of a good outcome from treatment is highest within the first 1-3 hours, and decreases dramatically thereafter. Most sites would initiate aggressive medical treatment before intervention – nimodipine, so called “Triple H” treatment, admission to the intensive care or HDU.

A CT scan is required to exclude other causes for neurological decline – mainly hydrocephalus or a re-bleed. It is preferable that the causative aneurysm has been secured (clipped or treated with endovascular occlusion) before treatment of vasospasm, but this is not seen as an absolute exclusion to treatment in critical circumstances.

What are the absolute contraindications for a SAH Vasospasm Endovascular Treatment?

Contrast allergy (severe).

What are the relative contraindications for a SAH Vasospasm Endovascular Treatment?

• Unprotected aneurysm
• Contrast allergy (mild)
• Renal impairment

What are the adverse effects of a SAH Vasospasm Endovascular Treatment?

• Death from artery rupture
• Failed procedure – stroke

Please see patient (consumer) information section for detailed description of procedural risks.

Are there alternative imaging tests, interventions or surgical procedures to a SAH Vasospasm Endovascular Treatment?

Diagnosis of vasospasm is initially based on clinical suspicion, with subsequent imaging proof. Most commonly this has come from DSA, with CT scan to exclude other problems such as intracranial bleed, large stroke or hydrocephalus.

TCD (transcranial Doppler ultrasound) has been used as a regular screening tool, but has some limitations and is not universally accepted as a useful tool. MRI or MRA has not routinely been used to diagnose spasm, and is only occasionally used in this setting. CTA may have an expanding role, particularly when combined with new techniques assessing cerebral perfusion, but has yet to assume a widespread usage.

*The author has no conflict of interest with this topic.

Page last modified on 22/8/2017.