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Endovascular management of cerebral vasospasm

Craig Kelman, M.D. and John Reavey-Cantwell, M.D., M.S. VCU Medical Center -- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia Cerebral vasospasm remains a feared complication from subarachnoid hemorrhage. Vasospasm typically occurs from three to fourteen days post--aneurysm rupture, with peak risk on day 7. Up to 50% of patients with angiographic vasospasm will subsequently develop delayed cerebral ischemia; 15--20% of this subset will develop stroke or death despite maximal medical therapy. We define symptomatic vasospasm as the presence of neurological worsening after exclusion of other identifiable causes, such as seizure, hydrocephalus, intracerebral hemorrhage, or metabolic dysfunction. This video demonstrates the set-up and treatment protocol for endovascular intervention of symptomatic vasospasm not responsive to maximal medical management.