Bracard S, Anxionnat R, Ducrocq X, Burdin D, Per A, Marchal J C, Auque J, Picard L
Service de neuroradiologie diagnostique et thérapeutique, CHU Nancy, hôpitaux urbains, France.
Ann Fr Anesth Reanim. 1996;15(3):382-6. doi: 10.1016/s0750-7658(96)80023-2.
Various therapeutic strategies have been recently proposed to prevent the vasospasm after subarachnoid haemorrhage, and to avoid its clinical consequences. Despite these progresses, mortality and morbidity of delayed ischaemic consequences of vasospasm remain important. Two endovascular treatments have been proposed. The successful use of transluminal angioplasty for vasospasm was first reported by Zubkov in 1984. Transluminal angioplasty is very effective with clinical improvement when the treatment is undertaken without delay after the onset of symptoms. Limitations of this technique are the inaccessibility of distal arteries and the risks (vascular rupture or occlusion). More recently, to overcome these limitations, a selective intraarterial infusion of papaverine has been proposed. These infusions are less risky and can be employed in distal vasospasm. However, clinical results seem to be less favourable and often transient. These two techniques are still used with slightly different indications. According to our experience, it seems reasonable to reserve transluminal angioplasty for symptomatic vasospasm, associated with papaverine or not, and to use papaverine alone in all other cases.
最近已经提出了各种治疗策略来预防蛛网膜下腔出血后的血管痉挛，并避免其临床后果。尽管取得了这些进展，但血管痉挛延迟性缺血后果的死亡率和发病率仍然很高。已经提出了两种血管内治疗方法。1984年，祖布科夫首次报道了经腔血管成形术成功用于治疗血管痉挛。当在症状发作后立即进行治疗时，经腔血管成形术对临床改善非常有效。该技术的局限性在于难以到达远端动脉以及存在风险（血管破裂或闭塞）。最近，为了克服这些局限性，有人提出了选择性动脉内注入罂粟碱的方法。这些注入风险较小，可用于远端血管痉挛。然而，临床结果似乎不太理想，而且往往是短暂的。这两种技术仍根据略有不同的适应症使用。根据我们的经验，将经腔血管成形术保留用于有症状的血管痉挛（无论是否联合罂粟碱），而在所有其他情况下单独使用罂粟碱似乎是合理的。
