2011+脑血管痉挛血管内治疗的重症监护指南.pdfVIP

Neurocrit Care (2011) 15:336–341 DOI 10.1007/s12028-011-9600-1 REVIEW Critical Care Guidelines on the Endovascular Management of Cerebral Vasospasm Matthew M. Kimball • Gregory J. Velat • Brian L. Hoh • The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage Published online: 15 July 2011 Springer Science+Business Media, LLC 2011 Abstract Cerebral vasospasm and delayed cerebral ische- Keywords Balloon angioplasty Intra-arterial mia account for significant morbidity and mortality after Nicardipine Papaverine Verapamil aneurysmal subarachnoid hemorrhage. While most patients are managed with triple-H therapy, endovascular treat- Introduction ments have been used when triple-H treatment cannot be used or is ineffective. An electronic literature search Cerebral vasospasm and delayed cerebral ischemia (DCI) was conducted to identify English language articles pub- account for the majority of morbidity and mortality for lished through October 2010 that addressed endovascular patients who survive to undergo treatment following aneu- management of vasospasm. A total of 49 articles were rysmal subarachnoid hemorrhage (SAH). Angiographic identified, addressing endovascular treatment timing, intra- vasospasm is observed in 30–70% of patients between days arterial treatments, and balloon angioplasty. Most of the 5 and 14 following the initial aneurysmal bleed [1, 2]. available studies investigated intra-arterial papaverine or Approximately 50% of patients with angiographic vaso- balloon angioplasty. Both have generally been shown to spasm will develop DCI,