Vasospasm intracranial aneurysm

Subarachnoid hemorrhage (SAH) is most commonly caused by rupture of an intracranial aneurysm. It can produce vasospasm that may cause ischemia and infarction. Currently, vasospasm has surpassed rebleeding as the most important complication after rupture of an aneurysm. Vasospasm due to SAH is thought to occur in the majority of cases of SAH (angiographic vasospasm is detectable in perhaps as many as 60-70% of patients after subarachnoid hemorrhage), but is symptomatic only in about a third of this population [81]. Symptomatic vasospasm carries a 15% to 20% risk of stroke or death. Vasospasm peaks around 1 week after SAH, but it can be seen as early as 3 days or as late as 3 weeks after the initial event [82], The underlying mechanisms are not understood, but vasospasm is clearly related to the amount of blood and its location in the subarachnoid space. Clinical symptoms generally develop slowly over a period of several hours to 1 or 2 days however, clinical evolution can be rapid in the onset with a stroke-like presentation [81, 82]. 

Condette-Auliac S, Bracard S, Anxionnat R, Schmitt E, Lacour JC, Braun M, Meloneto J, Cordebar A, Yin L, Picard L (2001) Vasospasm after subarachnoid hemorrhage interest in diffusion-weighted MR imaging. Stroke 32 1818-1824 Conway JE, Hutchins GM, Tamargo RJ (1999) Marfan syndrome is not associated with intracranial aneurysms. Stroke 30 1632-1636... 

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Vinuela F, Duckwiler G, Mawad M (1997) Guglielmi detachable coil embolization of acute intracranial aneurysm perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86 475-482 Vora YY, Suarez-Almazor M, Steinke DE, Martin ML, Findlay JM (1999) Role of transcranial Doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 44 1237-1247 discussion 1247-1248... 

Sasaki, T., Tanishima, T., Asano, T., 1979 Significance of lipid peroxidation in the genesis of chronic vasospasm following rupture of an intracranial aneurysm. Acta Neurochir. (Wien) (Suppl. 28), 536-540. 

Sensory systems Eyes A 55-year-old woman developed choroidal infarction with permanent visual loss after intracranial irrigation with papaverine 3 ml (30 mg/ml), used to prevent postoperative vasospasm after surgical clipping of a left middle cerebral artery aneurysm [161 ]. 

Various nondetachable balloons are available for temporary vessel occlusion, angioplasty for vasospasm therapy or remodelling techniques for broad based aneurysms. Larger vessels like the carotid or vertebral artery can be occluded with a double lumen balloon catheter, i.e. Meditech (Cook). For intracranial angioplasty and remodeling smaller, more flexible balloons, like the Hyperglide (MTI), Eclipse (Balt), or the Copernic (Balt) are required. Additionally to these balloons tbe Hyperform microballoon (MTI) can be used for remodelling technique. 

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