Role of intraarterial therapy for cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhage.

Article Details

Citation

Weant KA, Ramsey CN 3rd, Cook AM

Role of intraarterial therapy for cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhage.

Pharmacotherapy. 2010 Apr;30(4):405-17. doi: 10.1592/phco.30.4.405.

PubMed ID
20334460 [ View in PubMed
]
Abstract

Aneurysmal subarachnoid hemorrhage (SAH) accounts for a significant percentage of morbidity and mortality among patients admitted to neurosurgical centers throughout the world. Even for individuals surviving beyond the initial presentation and intervention for aneurysmal SAH, the occurrence of cerebral vasospasm has the potential to induce a second tier of complications that can be just as devastating as the inciting event. However, despite numerous studies and some initial advancements in management, therapeutic modalities are limited to help prevent or treat this complex entity. Historically, the mainstay of treatment for cerebral vasospasm has been a combination of hypervolemia, hemodilution, and hypertension. In addition, other systemic therapies such as oral nimodipine, statins, and intravenous magnesium, as well as intensive glucose control, appear to have some promise, although they are limited at times by adverse effects. To avoid these adverse consequences and perhaps gain some modicum of efficacy, attempts have been made to use endovascular techniques to physically dilate vessels or to administer drugs directly to the site of action and thus avoid many of the untoward effects of systemic pharmacotherapy. Controversy still remains over the success of intraarterial therapy, the drugs or techniques to be used, and the best timing of this therapy. Based on the currently available literature, it is impossible to assess the most effective intraarterial therapy. Randomized controlled trials that can control for baseline factors and technical expertise are needed to provide more conclusive data. Clinical pharmacists should be actively involved in assisting interventional radiologists and neurosurgeons in providing safe and appropriate pharmacotherapy in this promising but controversial arena of intraarterial drug delivery.

DrugBank Data that Cites this Article

Drug Targets
DrugTargetKindOrganismPharmacological ActionActions
NimodipineVoltage-dependent L-type calcium channel subunit alpha-1CProteinHumans
Yes
Inhibitor
Details
NimodipineVoltage-dependent L-type calcium channel subunit alpha-1DProteinHumans
Yes
Inhibitor
Details
NimodipineVoltage-dependent L-type calcium channel subunit alpha-1FProteinHumans
Yes
Inhibitor
Details
NimodipineVoltage-dependent L-type calcium channel subunit alpha-1SProteinHumans
Yes
Inhibitor
Details
NimodipineVoltage-dependent L-type calcium channel subunit beta-1ProteinHumans
Yes
Inhibitor
Details
NimodipineVoltage-dependent L-type calcium channel subunit beta-2ProteinHumans
Yes
Inhibitor
Details
NimodipineVoltage-dependent L-type calcium channel subunit beta-3ProteinHumans
Yes
Inhibitor
Details
NimodipineVoltage-dependent L-type calcium channel subunit beta-4ProteinHumans
Yes
Inhibitor
Details