BACKGROUND: Critical hypoperfusion and metabolic derangement are frequently encountered with refractory vasospasm. Endovascular rescue therapies (ERT) have proven beneficial in selected cases. However, angioplasty (AP) and intraarterial lysis (IAL) are measures of last resort and prospective, quantitative results regarding the efficacy (cerebral oxygenation, metabolism) are largely lacking. OBJECTIVE: To evaluate the efficacy of ERTs for medically refractory vasospasm using multimodal, continuous event neuromonitoring. METHODS: To detect cerebral compromise in a timely fashion, sedated patients with aneurysmal subarachnoid hemorrhage received continuous neuromonitoring (p ti O 2 measurement, intraparenchymal microdialysis). ERT (AP and/or IAL) was considered in cases of clinically relevant vasospasm refractory to conservative treatment measures. Oxygen saturation and cerebral and systemic metabolism before and after events of ERT was recorded. RESULTS: We prospectively included 13 consecutive patients and recorded a total of 25 ERT events: AP (n = 10), IAL (n = 11), or both (AP + IAL, n = 4). Average cerebral p ti O 2 was 10 ± 11 torr before and 49 ± 22 torr after ERT ( P < .001), with a lactate-pyruvate ratio decreasing from 146.6 ± 119.0 to 27.9 ± 10.7 after ERT ( P < .001). Comparable improvement was observed for each type of intervention (AP, IAL, or both). No significant alterations in systemic metabolism could be detected after ERT. CONCLUSION: Multimodal event neuromonitoring is able to quantify treatment efficacy in subarachnoid hemorrhage-related vasospasm. In our small cohort of highly selected cases, ERT was associated with improvement in cerebral oxygenation and metabolism with reasonable outcome. Event neuromonitoring may facilitate individual and timely optimization of treatment modality according to the individual clinical course.
BACKGROUND:Critical hypoperfusion and metabolic derangement are frequently encountered with refractory vasospasm. Endovascular rescue therapies (ERT) have proven beneficial in selected cases. However, angioplasty (AP) and intraarterial lysis (IAL) are measures of last resort and prospective, quantitative results regarding the efficacy (cerebral oxygenation, metabolism) are largely lacking. OBJECTIVE: To evaluate the efficacy of ERTs for medically refractory vasospasm using multimodal, continuous event neuromonitoring. METHODS: To detect cerebral compromise in a timely fashion, sedated patients with aneurysmal subarachnoid hemorrhage received continuous neuromonitoring (p ti O 2 measurement, intraparenchymal microdialysis). ERT (AP and/or IAL) was considered in cases of clinically relevant vasospasm refractory to conservative treatment measures. Oxygen saturation and cerebral and systemic metabolism before and after events of ERT was recorded. RESULTS: We prospectively included 13 consecutive patients and recorded a total of 25 ERT events: AP (n = 10), IAL (n = 11), or both (AP + IAL, n = 4). Average cerebral p ti O 2 was 10 ± 11 torr before and 49 ± 22 torr after ERT ( P < .001), with a lactate-pyruvate ratio decreasing from 146.6 ± 119.0 to 27.9 ± 10.7 after ERT ( P < .001). Comparable improvement was observed for each type of intervention (AP, IAL, or both). No significant alterations in systemic metabolism could be detected after ERT. CONCLUSION: Multimodal event neuromonitoring is able to quantify treatment efficacy in subarachnoid hemorrhage-related vasospasm. In our small cohort of highly selected cases, ERT was associated with improvement in cerebral oxygenation and metabolism with reasonable outcome. Event neuromonitoring may facilitate individual and timely optimization of treatment modality according to the individual clinical course.
Authors: Miriam Weiss; Walid Albanna; Catharina Conzen-Dilger; Nick Kastenholz; Katharina Seyfried; Hani Ridwan; Martin Wiesmann; Michael Veldeman; Tobias Philip Schmidt; Murad Megjhani; Henna Schulze-Steinen; Hans Clusmann; Marinus Johannes Hermanus Aries; Soojin Park; Gerrit Alexander Schubert Journal: Stroke Date: 2022-06-08 Impact factor: 10.170
Authors: Catharina Conzen; Walid Albanna; Miriam Weiss; David Kürten; Walthard Vilser; Konstantin Kotliar; Charlotte Zäske; Hans Clusmann; Gerrit Alexander Schubert Journal: Transl Stroke Res Date: 2017-11-08 Impact factor: 6.829
Authors: Miriam Weiss; Catharina Conzen; Marguerite Mueller; Martin Wiesmann; Hans Clusmann; Walid Albanna; Gerrit Alexander Schubert Journal: Front Neurol Date: 2019-02-21 Impact factor: 4.003
Authors: Tobias P Schmidt; Walid Albanna; Miriam Weiss; Michael Veldeman; Catharina Conzen; Omid Nikoubashman; Christian Blume; Daniel S Kluger; Hans Clusmann; Sven H Loosen; Gerrit A Schubert Journal: Front Neurol Date: 2022-03-10 Impact factor: 4.003
Authors: Michael Veldeman; Miriam Weiss; Tim Philipp Simon; Anke Hoellig; Hans Clusmann; Walid Albanna Journal: Neurosurg Rev Date: 2021-04-17 Impact factor: 3.042