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On the other hand, we feel that endovascular therapies may be potentially more beneficial as a treatment option. Encouraging results have been reported with intra-arterial administration of papaverine and angioplasty of accessible spastic vessels. Timing of endovascular treatment is critically important to be effective. Intervention should be performed soon after it is apparent that a patient is progressing or failing to improve despite maximal medical therapy and before the onset of cerebral infarction. Indeed, cerebral angiography with the possibility of angiopalsty has become a routine part of our protocol in the management of symptomatic vasospasm. Figure 1 shows an example of a patient with symptomatic basilar artery vasospasm who made a significant recovery (from obtundation to following commands) after angioplasty.

21-aminosteroid

21-aminosteroid

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