ABSTRACT
Endovascular therapy to treat symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) has become a mainstay in many centers. Cerebral vasospasm, defined as reversible vasoconstriction of the intracranial vasculature, is found in approximately 30% to 70% of patients after aSAH, although perhaps only one-third to one-half of these patients will develop symptoms and/or delayed ischemic neurologic deficits (DINDs). DINDs remain the leading cause of stroke, morbidity, and mortality after aSAH (1). The Fisher grade (Table 1) (2), scoring the amount of blood seen on the initial head computed tomography (CT) scan, remains a good predictor of the severity of vasospasm to be anticipated and the incidence of CT demonstrable infarction and associated morbidity and mortality. Whether patients presenting with aSAH are more likely to develop vasospasm, if treated by endovascular coiling versus craniotomy and clipping, is a matter of recent debate with evidence supporting both claims (3-5) and no prospective study as of yet performed.
