What is your approach to using intra-arterial or intrathecal vasodilators in patients with vasospasm in subarachnoid hemorrhage despite usage of oral nimodipine?

Bottom line up front: The 2023 AHA/ASA focused update on aSAH recommends IA vasodilator infusion or mechanical angioplasty in clinically significant vasospasm refractory to medical therapy (Class IIa, Level B) and states that intraventricular nicardipine “may be considered” in selected patients (Cla...

From an intervention perspective, escalation is driven primarily by clinical exam, with TCD trends and imaging used for correlation. As the prior answer noted, vasospasm and delayed cerebral ischemia are overlapping but not synonymous entities. For that reason, I don’t require elevated TCD velocitie...