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P231 BACKGROUND AND PURPOSE: Symptomatic vasospasm  remains an important cause of morbidity and mortality in patients with  subarachnoid hemorrhage (SAH). Endovascular techniques have recently  been introduced for treatment of vasospasm resistant to medical  treatment. We performed this study to determine the safety and efficacy  of these techniques in a large series of patients with SAH.METHODS: We reviewed the medical records, angiograms, and  computed tomographic (CT) scans for patients who underwent endovascular  treatment for symptomatic vasospasm at 3 university-affiliated centers.  The following outcomes were analyzed; angiographic improvement,  neurological improvement, ability to prevent cerebral infarction as  demonstrated by serial CT scans, and outcome at 3 months using Glasgow  Outcome Scale (GOS).RESULTS: Forty-five patients (mean age  51 ±10 years; 13 were men) were treated for symptomatic vasospasm. The  vasospasm was graded as severe (n=27), moderate (n=16), and mild (n=2)  by angiographic criteria. Angioplasty was performed in 26 patients;  intra-arterial papaverine was administered as adjunctive therapy in 11  procedures. Nineteen patients were treated with intra-arterial  papaverine alone. Angiographic improvement was documented in all  patients. Cerebral infarction was observed in 29 (64%) of 45 patients  on follow-up CT scan. Good outcome (minimal or no disability by GOS)  was seen in 12 (27%) patients.CONCLUSIONS: Although  endovascular treatment of symptomatic vasospasm results in good  angiographic response, a high proportion of cerebral infarction and  poor outcomes is still observed in patients who failed medical  treatment. New strategies need to be developed to improve outcome in  this subset of patients with SAH.

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Multicenter Evaluation of the Efficacy of Endovascular Treatment for Symptomatic Vasospasm unresponsive to Hypervolemic and Hypertensive Therapy in Patients with Subarachnoid Hemorrhage.