Question

Discuss endovascular treatment of vasospasm in aneurysmal sub-arachnoid hemorrhage.

Hint:

Endovascular treatment provides a direct and effective approach to reversing vasospasm and preventing ischemic damage in aneurysmal SAH.

Answer 1

Endovascular treatment of vasospasm in aneurysmal sub-arachnoid hemorrhage (SAH) is an effective intervention used when medical management fails to prevent or resolve vasospasm. The goal is to restore normal blood flow to affected areas of the brain.
Step 1: Angioplasty:
1. Balloon Angioplasty: In this procedure, a balloon catheter is inserted into the narrowed artery and inflated to dilate the vessel. This can temporarily relieve the vasospasm and restore cerebral blood flow.
2. Indications: Balloon angioplasty is usually performed in patients who have not responded to medical treatment and have demonstrated significant clinical deterioration due to vasospasm.
Step 2: Intra-arterial Vasodilators:
1. Drugs Used: Intra-arterial infusion of vasodilators, such as nimodipine, verapamil, or papaverine, can help relax the smooth muscles of the cerebral arteries and improve blood flow.
2. Procedure: A catheter is inserted through the femoral artery to the site of the vasospasm, and the vasodilator is administered directly into the affected artery.
Step 3: Combination Therapy:
1. Angioplasty with Vasodilators: Sometimes, a combination of balloon angioplasty and intra-arterial vasodilators is used for patients with severe vasospasm that does not respond to a single treatment.