Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector49010.17816/ACEN.2017.3.9ReviewsОбзорыUnknownChemical angioplasty for the treatment of cerebral vasospasm in patients with ruptured cerebral aneurysmХимиоангиопластика в лечении сосудистого спазма у пациентов с разрывами аневризм артерий головного мозгаKalinkinAleksandr A.КалинкинАлександр А.
Russian Federation
aleksandr_kalinkin27@mail.ruPetrikovSergey S.ПетриковСергей С.
Russian Federation
aleksandr_kalinkin27@mail.ruN.V. Sklifosofskiy Research Institute of Emergency CareГБУЗ г. Москвы «НИИ скорой помощи им Н.В. Склифосовского Департамента здравоохранения города Москвы»28092017113606728092017Copyright ©; 2017, Kalinkin A.A., Petrikov S.S.Copyright ©; 2017, Kalinkin A.A., Petrikov S.S.2017Kalinkin A.A., Petrikov S.S.Kalinkin A.A., Petrikov S.S.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/490

Vasospasm of cerebral arteries is considered to be the main reason of unfavorable outcomes in patients in acute period of ruptured arterial aneurysms. Despite of availability of various therapeutic approaches, there is no effective way to prevent and to treat vasospasm so far. However, according to recently published works chemical angioplasty in considered as a promising technique for the treatment of vasospasm. This approach implies invasive drug administration in the narrowed segments of cerebral arteries which allows medicine to affect endothelium of cerebral arteries directly. This route of administration prevents development of systemic effects of a drug and decrease of plasma drug concentration because of its metabolism in liver. Chemical angioplasty is used not only in proximal but also in distal parts of the constricted cerebral artery. In this review, we touch upon the use of chemical angioplasty for the treatment of vasospasm in patients with subarachnoid hemorrhage due to rupture of intracranial aneurysms. The most widely used drugs for chemical angioplasty include papaverine, verapamil, nimodipinе, nicardipine, fasudil hydrochloride, and milrinone. Studies of this treatment approach show promising results confirming its efficacy in the management of vasospasm in patients with subarachnoid hemorrhage due to rupture of intracranial aneurysms.

Сосудистый спазм церебральных артерий является основной причиной неблагоприятных исходов заболевания у пациентов в остром периоде разрыва артериальных аневризм.

Несмотря на применение различных методов терапии, до настоящего времени нет эффективного способа профилактики и лечения сосудистого спазма. В последнее время в литературе появляются публикации результатов исследований, в которых получены обнадеживающие результаты применения химиоангиопластики в лечении сосудистого спазма. Химиоангиопластика представляет собой инвазивное введение лекарственных препаратов в суженные сегменты церебральных артерий. При данном способе лечения происходит воздействие лекарственного средства непосредственно на эндотелий церебральных артерий, исключаются системные эффекты и снижение плазменной концентрации препарата вследствие его первичного прохождения через печень. Химиоангиопластику используют для восстановления проходимости не только проксимальных, но и дистальных участков спазмированных артерий головного мозга. В данном обзоре литературы освещен способ лечения сосудистого спазма у больных с субарахноидальным кровоизлиянием вследствие разрыва аневризм сосудов головного мозга с помощью химиоангиопластики. Наиболее распространенными препаратами для проведения химиоангиопластики являются папаверин, верапамил, нимодипин, никардипин, фазудил гидрохлорид, милринон и колфоросин дорапат. Полученные обнадеживающие результаты подтверждают эффективность и перспективность данного метода лечения сосудистого спазма у больных с кровоизлиянием вследствие разрыва артериальных аневризм.

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