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.
How, then, would we go about repair of ischemic brain? One point Robert Ettinger made 20 years ago still stands, and is quite profound. In The Prospect Of Immortality , Bob made the comment that brain cells after ischemia (or freezing) simply are not universally destroyed. Even in adult human beings, significant areas of brain can survive lengthy periods of ischemia. What does that mean? Bob described a column of soldiers after a machine gun attack. If none of the soldiers ever gets up or shows any sign of life, then they've probably all been killed. But if only a few get up afterward, then many more are probably wounded but still alive.