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Inertial cavitation inducing ultrasound-mediated microbubble treatments can produce resolution of vasospasm and restoration of distal arterial flow after peripheral artery injury. Resolution of catheter-induced vasospasm is likely to be nitric oxide- mediated because improvements in stenosis diameter and downstream blood flow were blunted following pretreatment with L-NAME. The potential for clinical applicability of this therapy is significant because: 1) microbubbles can be delivered systemically into the site of injury enabling relatively high local concentration; 2) targeted transcutaneous ultrasound delivery is achievable due to the proximity of vessels; and 3) microbubbles and diagnostic ultrasound system used are commercially available.

Excessive consumption of over-the-counter stimulants is associated with coronary vasospasm, thrombotic complications, and sudden cardiac death. Their effects on cerebrovascular physiology are not yet described in the neurointerventional literature. Patients are increasingly exposed to high levels of these vasoactive substances in the form of caffeinated energy drinks and specialty coffees. We report a case of aneurysmal subarachnoid hemorrhage (SAH) and severe, catheter-induced vasospasm during attempted endovascular repair of a ruptured anterior communicating artery (AComA) aneurysm in the setting of excessive energy drink consumption. We review the literature and alert clinicians to this potentially serious complication. [ABSTRACT FROM AUTHOR]