Department of Neurosurgery, University of Florida, 1600 South West Archer Rd, P.O. Box 100265, Gainesville, FL 32610, USA.
Neurocrit Care. 2011 Sep;15(2):336-41. doi: 10.1007/s12028-011-9600-1.
Cerebral vasospasm and delayed cerebral ischemia account for significant morbidity and mortality after aneurysmal subarachnoid hemorrhage. While most patients are managed with triple-H therapy, endovascular treatments have been used when triple-H treatment cannot be used or is ineffective. An electronic literature search was conducted to identify English language articles published through October 2010 that addressed endovascular management of vasospasm. A total of 49 articles were identified, addressing endovascular treatment timing, intra-arterial treatments, and balloon angioplasty. Most of the available studies investigated intra-arterial papaverine or balloon angioplasty. Both have generally been shown to successfully treat vasospasm and improve neurological condition, with no clear benefit from one treatment compared with another. There are reports of complications with both therapies including vessel rupture during angioplasty, intracranial hypertension, and possible neurotoxicity associated with papaverine. Limited data are available evaluating nicardipine or verapamil, with positive benefits reported with nicardipine and inconsistent benefits with verapamil.
脑动脉痉挛和迟发性脑缺血是蛛网膜下腔出血后发病率和死亡率高的主要原因。大多数患者采用三重 H 治疗，但当三重 H 治疗无效或不能使用时，则采用血管内治疗。进行了电子文献检索，以确定截至 2010 年 10 月发表的用英文撰写的解决血管痉挛血管内治疗的文章。共确定了 49 篇文章，涉及血管内治疗时机、动脉内治疗和球囊血管成形术。大多数现有研究调查了动脉内罂粟碱或球囊血管成形术。两者通常都能成功治疗血管痉挛和改善神经状况，而与另一种治疗相比，没有明显的优势。这两种治疗方法都有报道出现并发症，包括血管成形术中血管破裂、颅内压升高和罂粟碱可能引起的神经毒性。关于尼卡地平或维拉帕米的数据有限，尼卡地平有积极的益处，而维拉帕米的益处则不一致。
