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E-044 Endovascular treatment of ruptured brain aneurysms and subsequent vasospasm as a result of intracranial hemorrhage

The aim of the study was to analyze big series of ruptured brain aneurysms with subsequent vasospasm treated in the Acad N. Burdenko Institute of Neurosurgery. Methods In the period from 1997 to 2016 132 patients (133 aneurysms) in acute stage of SAH (21 days) were treated. Age of the patients from 2 to 79 years. Anterior circulation – 83 (62.87%), posterior circulation aneurysms – 49 (37.13). Intaarterial injection of verapamil for treatment of cerebral spasm was performed in 41 patients. Total 82 procedures after closing ruptured aneurysm in acute stage of SAH. Age from 12 to 79 years. Efficacy of intervention was evaluated by the administration of transcranial Doppler ultrasound and clinically by modified Rankin scale. Multiple treatments (2–5 times). Dynamic selection of a dose (5–40 mg). Results The rate of coil and stent migration was 3% (4 patients). For 5 patients (3.78%) EV access to aneurysm failed due to severe spasm. The rate of thromboembolic complications was low (3%, 4 patients). Also rate of rerupture was low (5.3%, 7 patients). However, there was significantly high rate of increasing spasm (7.57%, 10 patients). Mortality was in 4 patients (3%). Conclusion Patients with ruptured brain intracranial aneurysms in case of subsequent spasm were significantly more likely to be treated via endovascular management compared with microsurgery. Endovascular occlusion method could prevent second-time rupture effectively, lower the death rate, and at the same time lower the occurrence of cerebral vasospasm and the succeeding damage caused. Disclosures K. Mikeladze: None. S. Yakovlev: None. A. Bocharov: None. E. Bukharin: None. K. Orlov: None.