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Stellate ganglion block combined with intra-arterial treatment: a “one-stop shop” for cerebral vasospasm after aneurysmal subarachnoid hemorrhage—a pilot study

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Delayed cerebral ischemia (DCI) is a frequent cause of morbidity and mortality in patients with cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage (aSAH). Refractory CV remains challenging to treat and often leads to permanent deficits and death despite aggressive therapy. We hereby report the feasibility and safety of stellate ganglion block (SGB) performed with a vascular roadmap-guided technique to minimize the risk of accidental vascular puncture and may be coupled to a diagnostic or therapeutic cerebral angiography.

Methods

In addition to a detailed description of the technique, we performed a retrospective analysis of a series of consecutive patients with refractory CV after aSAH that were treated with adjuvant roadmap-guided SGB. Clinical outcomes at discharge are reported.

Results

Nineteen SGB procedures were performed in 10 patients, after failure of traditional hemodynamic and endovascular treatments. Each patient received 1 to 3 SGB, usually interspaced by 24 h. In 4 patients, an indwelling microcatheter for continuous infusion was inserted. First SGB occurred on average 7.3 days after aSAH. SGB was coupled to intra-arterial nimodipine infusion or balloon angioplasty in 9 patients. SGB was technically successful in all patients. There were no technical or clinical complications.

Conclusion

Adjuvant SGB may be coupled to endovascular therapy to treat refractory cerebral vasopasm within the same session. To guide needle placement, using a roadmap of the supra-aortic arteries may decrease the risk of complications. More prospective data is needed to evaluate the therapeutic efficacy, durability, and safety of SGB compared with the established standard of care.

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Author notes

  1. Marco Pileggi and Pascal J. Mosimann contributed equally to this work.

Authors and Affiliations

  1. Department of Interventional and Diagnostic Neuroradiology, Neurocenter of Southern Switzerland, Via Tesserete 46, 6900, Lugano, Switzerland

    Marco Pileggi, Maurizio Isalberti & Alessandro Cianfoni

  2. Department of Interventional and Diagnostic Neuroradiology, Inselspital, University Hospital of Bern, Bern, Switzerland

    Pascal J. Mosimann, Eike Immo Piechowiak & Alessandro Cianfoni

  3. Intensive Care Unit, Lugano Regional Hospital, Lugano, Switzerland

    Paolo Merlani

  4. Department of Anesthesiology, Intensive Care and Pharmacology, University Hospital of Geneva, Geneva, Switzerland

    Paolo Merlani

  5. Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland

    Michael Reinert

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  1. Marco Pileggi
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Correspondence to Marco Pileggi.

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Pileggi, M., Mosimann, P.J., Isalberti, M. et al. Stellate ganglion block combined with intra-arterial treatment: a “one-stop shop” for cerebral vasospasm after aneurysmal subarachnoid hemorrhage—a pilot study. Neuroradiology 63, 1701–1708 (2021). https://doi.org/10.1007/s00234-021-02689-9

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  • DOI: https://doi.org/10.1007/s00234-021-02689-9

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