Introduction The results of endovascular embolisation of intracranial aneurysms are promising, given the risk of surgery in difficult cases [1±5]. Despite improvements in manage- ment of subarachnoid haemorrhage SAH), cerebral vasospasm remains an important cause of morbidity and mortality in aneurysmal SAH. Up to 70 % of patients with SAH suffer from vasospasm within the first 10 days after rupture of an aneurysm [6]; symptomatic vaso- spasm with neurological deficit occurs in 20±30 % [7]. In patients with symptomatic vasospasm surgical clipping of the aneurysm often results in a poor clinical outcome [8, 9]; an alternative way of treating the aneurysm and the vasospasm would thus be desirable. Endovascular embolisation of aneurysms with Guglielmi detachable coils GDC) has proved an alternative to surgical clip- ping [5, 10]. Intra-arterial infusion of papaverine and/or balloon angioplasty have been reported to be effective in treatment of vasospasm refractory to conservative therapy ªtriple Hº and calcium antagonists) [11±20]. Case reports Case 1 A 41-year-old woman had two episodes of headache 5 days and 1 day prior admission. She was in Hunt and Hess grade I. On CT there was no evidence of SAH or an infarct. Digital subtraction angiography DSA) revealed an aneurysm of the anterior com- municating artery, without vasospasm, and surgical clipping was planned for the following day. The patient, however, gradually be- came drowsy and developed a severe left hemiparesis during the night. Repeat DSA revealed marked spasm of the distal internal carotid and anterior cerebral arteries ACA), the aneurysm still being visible Fig.1a). The decision was made to treat the aneur- ysm via the endovascular approach and try to treat the vasospasm during the same procedure. It was not possible to pass the narrow arterial segment with a Tracker 10 microcatheter. Embolisation of Neuroradiology 2000) 42: 926±929 Ó Springer-Verlag 2000 INTERVENTIONAL NEURORADIOLOGY I. Wanke A. Dörfler U. Dietrich T. Aalders M. Forsting Combined endovascular therapy of ruptured aneurysms and cerebral vasospasm Received: 5 November 1999 Accepted: 12 July 2000 I.Wanke ´ A.Dörfler ´ U.Dietrich ´ T.Aalders ´ M.Forsting Department of Neuroradiology and Department of Neurosurgery, University of Essen, Hufelandstrasse 55, Essen D-45122, Germany Corresponding author: Isabel Wanke, MD, Department of Neu- roradiology, University of Essen, Hufe- landstrasse 55, Essen D-45122, Germany Tel.: 49-201-7231539 Fax: 49-2017235959 email: isabel.wanke@uni-essen.de Abstract We describe two patients with subarachnoid haemorrhage due to a ruptured intracranial an- eurysm and severe symptomatic va- sospasm. The aneurysm was oc- cluded with detachable coils fol- lowed by intra-arterial infusion of papaverine to treat vasospasm as an one-stage procedure. There was sig- nificant resolution of the vasospasm. The long-term clinical outcome in one patient was excellent, the other still has minor deficits. Combined endovascular aneurysm therapy fol- lowed by intra-arterial spasmolysis with papaverine is a technically fea- sable therapeutic alternative in pa- tients with symptomatic vasospasm. Key words Aneurysm, intracranial × Haemorrhage, subarachnoid × Vasospasm × Embolisation × Spasmolysis, intra- arterial