Chemical angioplasty for the treatment of cerebral vasospasm in patients with ruptured cerebral aneurysm

Abstract

Vasospasm of cerebral arteries is considered to be the main reason of unfavorable outcomes in patients in acute period of ruptured arterial aneurysms. Despite of availability of various therapeutic approaches, there is no effective way to prevent and to treat vasospasm so far. However, according to recently published works chemical angioplasty in considered as a promising technique for the treatment of vasospasm. This approach implies invasive drug administration in the narrowed segments of cerebral arteries which allows medicine to affect endothelium of cerebral arteries directly. This route of administration prevents development of systemic effects of a drug and decrease of plasma drug concentration because of its metabolism in liver. Chemical angioplasty is used not only in proximal but also in distal parts of the constricted cerebral artery. In this review, we touch upon the use of chemical angioplasty for the treatment of vasospasm in patients with subarachnoid hemorrhage due to rupture of intracranial aneurysms. The most widely used drugs for chemical angioplasty include papaverine, verapamil, nimodipinе, nicardipine, fasudil hydrochloride, and milrinone. Studies of this treatment approach show promising results confirming its efficacy in the management of vasospasm in patients with subarachnoid hemorrhage due to rupture of intracranial aneurysms.

Keywords

• aneurysm, subarachnoid hemorrhage, vasospasm, brain ischemia