Vasospasm after aneurysmal subarachnoid hemorrhage: recent advances in endovascular management

Curr Opin Crit Care. 2010 Apr;16(2):110-6. doi: 10.1097/MCC.0b013e3283372ef2.


Purpose of review: In a rapidly advancing specialty, it is essential to review the recent studies of alternative new treatments and present their efficacy, safety and outcome. We discuss the recent advances in the endovascular treatment of cerebral vasospasm following aneurysmal subarachnoid hemorrhage in the past few years with special focus on the literature regarding this subject in the last 18-24 months.

Recent findings: The recent findings are as follows: effect of papaverine on brain oxygen; recent evaluation concerning nimodipine use; combined intraarterial and intravenous use of milrinone; illustration of the numerous recent studies on nicardipine; the safety and efficacy of high-dose intraarterial verapamil; outcome and adverse effects of intraarterial fasudil; transluminal balloon angioplasty; and recent evaluation of its efficacy and evaluation of its prophylactic use.

Summary: Endovascular treatment, including intraarterial vasodilators and transluminal balloon angioplasty, has a very important place in the management of symptomatic vasospasm related to aneurysmal subarachnoid hemorrhage. The efficacy of intraarterial vasodilators has been proven. Numerous studies and analysis of different treatments of cerebrovascular vasospasm took place in the past period. This allowed more understanding and evaluation of their outcome, safety and efficacy helping physicians to choose better treatments to adopt. It emphasizes also the aspects that need more study and research.

Publication types

  • Review

MeSH terms

  • 1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine / analogs & derivatives
  • 1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine / therapeutic use
  • Angioplasty, Balloon
  • Critical Care
  • Endovascular Procedures*
  • Humans
  • Intensive Care Units
  • Milrinone / therapeutic use
  • Nicardipine / therapeutic use
  • Papaverine / therapeutic use
  • Risk Factors
  • Subarachnoid Hemorrhage / complications*
  • Subarachnoid Hemorrhage / pathology
  • Subarachnoid Hemorrhage / therapy
  • Vasodilator Agents / therapeutic use
  • Vasospasm, Intracranial / etiology*
  • Vasospasm, Intracranial / therapy
  • Verapamil / therapeutic use


  • Vasodilator Agents
  • 1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine
  • Verapamil
  • Nicardipine
  • Papaverine
  • Milrinone
  • fasudil