Journal of vascular and interventional neurology
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J Vasc Interv Neurol · Jun 2014
Case report: Intra-procedural aneurysm rupture during endovascular treatment causing immediate, transient angiographic vasospasm.
Cerebral vasospasm is a major cause of delayed ischemic cerebral injury, typically occurring 3-14 days after subarachnoid hemorrhage (SAH). Ultra-early vasospasm is defined as angiographic vasospasm observed within 48 h of SAH onset. Immediate vasospasm at the time of aneurysmal rupture has been suspected, but has not been previously reported. We describe a case of immediate, transient vasospasm following intra-procedural aneurysmal rupture. ⋯ We document a case of ultra-early cerebral vasospasm that occurred immediately after an intra-procedural aneurysmal rupture. Catheter-induced vasospasm from mechanical manipulation of extracranial vasculature is well described. However, immediate vasospasm related to extravascular blood has never before been reported. This finding suggests that extravascular blood can have a local direct effect (presumably mechanical) on cerebral blood vessels, and may be an important mechanism for vasospasm.