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The morbidity and mortality associated with aneurysmal subarachnoid hemorrhage (aSAH) have decreased due to early aneurysm repair, treatment of acute hydrocephalus, and a focus on the prevention, recognition, and treatment of delayed cerebral ischemia (DCI). Cerebral vasospasm, a well-recognized cause of DCI, is responsive to treatment. The treatment includes hypertensive therapy, calcium channel blockers, intra-arterial (IA) balloon angioplasty, and IA drug interventions. Modern endovascular techniques make IA delivery a safe and viable option for vasodilator and neuroprotective drug interventions. IA vasodilators reverse vasospasm. However, their impact on survival remains to be proven in randomized control trials. This chapter reviews the pathology of cerebral vasospasm, its treatment, limitations, and future arterial vasodilator interventions.

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Intraarterial Vasodilator Treatment for Cerebral Vasospasm After SAH: Where Are We and Where Do We Go?

  • 章节

  • 发表日期：

    2025年

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  • Jonathan Sisti,
  • Grace Russo,
  • Colin Sperring,
  • Srini Cherukuri

摘要

The morbidity and mortality associated with aneurysmal subarachnoid hemorrhage (aSAH) have decreased due to early aneurysm repair, treatment of acute hydrocephalus, and a focus on the prevention, recognition, and treatment of delayed cerebral ischemia (DCI). Cerebral vasospasm, a well-recognized cause of DCI, is responsive to treatment. The treatment includes hypertensive therapy, calcium channel blockers, intra-arterial (IA) balloon angioplasty, and IA drug interventions. Modern endovascular techniques make IA delivery a safe and viable option for vasodilator and neuroprotective drug interventions. IA vasodilators reverse vasospasm. However, their impact on survival remains to be proven in randomized control trials. This chapter reviews the pathology of cerebral vasospasm, its treatment, limitations, and future arterial vasodilator interventions.