Jefferson Neurosurgeons Use New Procedure To Reverse Dangerous Cerebral Vasospasm

October 13, 1998

Neurosurgeons at Jefferson Medical College have developed a method to reverse dangerous cerebral vasospasms. Vasospasm is a narrowing of cerebral arteries several days after aneurysm rupture. It is the leading cause of neurological disability and death in survivors of ruptured aneurysms.

Jeffrey Thomas, M.D., assistant professor of neurosurgery at Thomas Jefferson University in Philadelphia, and his colleagues have so far successfully treated 16 patients since March 1997. Each patient had failed conventional treatment for vasospasm.

"Clinical outcomes in treatment of these patients have been excellent, even in some patients with coma and partial paralysis before treatment," says Dr. Thomas. "Most of these patients have survived without significant neurological deficit from vasospasm." The neurosurgeons used a class of drug that dilates the cerebral blood vessels. According to Dr. Thomas, the drug is given by a specialized neurosurgical technique.

The drug is given immediately in the space around the brain and into the cerebrospinal fluid, which bathes the brain. The drug expands the brain's blood vessels, reversing the constricting effects of the vasospasm within about 30 minutes. The treatment currently is being evaluated as a preventive measure for ischemic stroke from vasospasm, with very encouraging initial results. Dr. Thomas presented his results last week at the Congress of Neurological Surgeons in Seattle.

A ruptured aneurysm is a hemorrhagic stroke, one of two types of stroke (the other is ischemic, caused by a reduced blood flow to the brain). When an aneurysm, which is a weakness in a blood vessel wall, erupts in the brain, it spills blood into the subarachnoid space around the brain. This is called a subarachnoid hemorrhage.

Neurosurgeons can operate and eliminate the aneurysm by placing a titanium clip or by a new less invasive procedure called coil embolization. In this procedure, the cerebral aneurysm is eliminated through a tiny incision in the patient's leg. These surgeries are generally successful. A week later, however, cerebral vasospasm can occur. Blood vessels constrict, which may be severe enough to cause ischemic stroke.

"Although patients survive the hemorrhage and come through surgery well, and the aneurysm is cured, the patient may suffer an ischemic stroke from vasospasm up to two weeks later, despite appearing well initially," Dr. Thomas explains. "The exact reasons are unclear, though recent advances in molecular biology have shed light on the mechanism." He has been studying this on the molecular level for about five years.

About 30,000 people a year in North America are candidates for such a procedure to treat cerebral vasospasm, he says, and about 10-12 of every 100,000 worldwide. Roughly 30 percent of patients develop the potentially life-threatening or disabling type of vasospasm.

"No one has ever had a specific and reliable treatment for cerebral vasospasm. It has potential to save lives and get people out of the hospital sooner, and save health care dollars as well," Dr. Thomas says.

"People with ruptured aneurysms are among the sickest patients in medicine, with hospital stays of months. A hospital stay for a patient complicated by vasospasm may cost a half million dollars. And half of those who survive the aneurysm need rehabilitation. If we can eliminate vasospasm as a complication, we can save resources as well as lives."

Thomas Jefferson University

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to