Beneficial Effect of Selective Intra-arterial Infusion of Fasudil Hydrochloride as a Treatment of Symptomatic Vasospasm
Introduction: We envisage the efficacy and safety of intra-arterial infusion of fasudil hydrochloride (IAF) for symptomatic vasospasm (SVS) after subarachnoid hemorrhage (SAH). We compared results obtained from the groups that received selective IAF (a mi
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Abstract Introduction: We envisage the efficacy and safety of intra-arterial infusion of fasudil hydrochloride (IAF) for symptomatic vasospasm (SVS) after subarachnoid hemorrhage (SAH). We compared results obtained from the groups that received selective IAF (a microcatheter inserted in intracranial arteries) and nonselective IAF (a microcatheter inserted in the cervical arteries). Glasgow Outcome Scale (GOS) value and computed tomographic (CT) score were used to evaluate clinical outcome and the extent of infarction due to delayed vasospasm. Material and methods: Over 2 years, 113 patients with SAH underwent clipping or coiling. Among them, 31 patients (27.4%) developed SVS. We performed nonselective IAF in 10 patients and selective IAF in 10 other patients. Eleven patients with SVS were treated without IAF. The data were statistically analyzed. Result: By univariate linear regression analysis, IAF negatively correlated with CT score (p = 0.016), but IAF was significantly correlated with GOS (p = 0.035). By multiple regression analysis, Hunt and Kosnik grade and CT score significantly correlated with GOS. Discussion: CT score significantly correlated with functional outcome. Although IAF, both selective and nonselective, was significantly effective for the treatment of delayed vasospasm, the former seemed to be more beneficial. Keywords Aneurysm • Subarachnoid hemorrhage • Symptomatic vasospasm • Intra-arterial infusion • Fasudil hydrochloride (FA)
T. Nakamura, M.D., T. Matsui, M.D., D.MSc. (), A. Hosono, M.D., A. Okano, M.D., N. Fujisawa, M.D., T. Tsuchiya, M.D., M. Indo, M.D., Y. Suzuki, M.D., S. Oya, M.D., D.MSc., and H.S. Chang, M.D., D.MSc. Department of Neurosurgery, Saitama Medical Center/Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama 350-8550, Japan e-mail: [email protected]
Introduction Recently, fasudil hydrochloride (IAF) for treatment of symptomatic vasospasm (SVS) following subarachnoid hemorrhage (SAH) has been widely used in Japan [1, 2, 5, 7–9]. Fasudil hydrochloride (FA) is a Rho kinase inhibitor (RKI), attenuating smooth muscle contraction of cerebral artery. In Japan, intravenous administration of RKI is widely accepted for prevention of delayed cerebral vasospasm after SAH [6]. From a retrospective point of view, we have analyzed a correlation between intra-arterial infusion of FA (IAF) and final outcome of the symptomatic vasospasm (SVS) cases to envisage the usefulness of IAF in treatment of SVS. In addition, we compared results obtained from the groups that received selective IAF (In these patients, a catheter was inserted into the A1, M1, M2, C1, C2 segment close to the spastic arteries) and nonselective IAF (in these patients, a catheter was placed in the extradural portion of the internal carotid artery or vertebral artery). In this report, we demonstrate more beneficial effect of IAF in the former group than in the latter group as a treatment of SVS following SAH.
Materials and Methods Treatment Strategy for SVS Our clinical path for patients with SAH is as follo
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