Efficacy of percutaneous transluminal angioplasty and intra-arterial infusion of fasudil hydrochloride on cerebral vasospasm following subarachnoid hemorrhage

In this study, the efficacy of percutaneous transluminal angioplasty (PTA) and intra-arterial infusion of fasudil hydrochloride (FH) on cerebral vasospasm after subarachnoid hemorrhage were reviewed. Twenty-two arterial territories in 15 patients were treated according to the following strategy. Vasospasm located on the proximal intracranial vessels (ICA and M1) was treated with PTA and intra-arterial infusion of FH was selected for vasospasm at more distal locations. Angiographic improvement of vasospasm was demonstrated in 19 territories (86%) and 9 of 11 symptomatic patients (82%) showed neurological improvement after the procedure. Angiographic vasoconstriction recurred in 7 territories (43%), and neurological deficits recurred in 3 patients (33%). Recurrence of vasoconstriction was seen only after intra-arterial infusion of FH. After treating the 22 vascular territories, 16 (73%) were prevented from large ischemic change on post-procedural computed tomographies. There were no episodes of systemic hypotension and no severe adverse effects were encountered. We concluded that the combined use of PTA and intra-arterial infusion of FH was useful for cerebral vasospasm following subarachnoid hemorrhage.