Effect of transluminal angioplasty on cerebral blood flow in the management of symptomatic vasospasm following aneurysmal subarachnoid hemorrhage

• Published in: Journal of neurosurgery Vol. 86; no. 5; pp. 830 - 839
• Main Authors: FIRLIK, A. D, KAUFMANN, A. M, JUNGREIS, C. A, YONAS, H
• Format: Journal Article
• Language: English
• Published: Park Ridge, IL American Association of Neurological Surgeons 01-05-1997
• Subjects: Adult; Angioplasty, Balloon - adverse effects; Biological and medical sciences; Cerebral Angiography; Cerebrovascular Circulation; Diseases of the cardiovascular system; Female; Humans; Intracranial Aneurysm - complications; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - physiopathology; Ischemic Attack, Transient - therapy; Male; Medical sciences; Middle Aged; Nervous System - physiopathology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Subarachnoid Hemorrhage - complications; Subtraction Technique; Tomography, X-Ray Computed; Xenon; Human; Intracranial; Nervous system diseases; Vasodilator agent; Radiodiagnosis; Xenon; Instrumentation therapy; Cardiovascular disease; Radioisotope; Hemorrhage; Cerebral disorder; Blood flow; Vascular disease; Dissecting aneurysm; Refractory; Central nervous system disease; Subarachnoid; Medical imagery; Vasospasm; Computerized axial tomography; Intraarterial administration; Hemodynamics; Papaverine; Cerebrovascular disease
• ISSN: 0022-3085; 1933-0693
• DOI: 10.3171/jns.1997.86.5.0830

In this study the authors have examined the effects of transluminal angioplasty on cerebral blood flow (CBF) in the management of intractable vasospasm following aneurysmal subarachnoid hemorrhage (SAH). Fourteen consecutively enrolled patients underwent attempted angioplasty with or without intraarterial infusion of papaverine. Twelve patients underwent pre- and postangioplasty xenon-enhanced computerized tomography (Xe-CT) scanning to measure regional CBF in 55 to 65 regions of interest (ROIs) per patient. Angioplasty was possible in 13 (93%) of 14 patients, with angiographically demonstrated improvement in all 13. Twelve (92%) of the 13 patients were neurologically improved following angioplasty; seven (58%) of the 12 patients who improved had a complete reversal of all delayed ischemic deficits. Angioplasty significantly decreased the mean number of ROIs at risk (11.4 ROIs pre- and 0.9 ROIs postangioplasty) (p < 0.00005, t-test). All patients had a reduction in the number of ROIs at risk after angioplasty; six (50%) of 12 no longer had any ROIs remaining at risk after angioplasty. Angioplasty significantly increased the mean CBF within at-risk ROIs (13 ml/100 g/minute pre- and 44 ml/100 g/minute postangioplasty) (p < 0.00005, t-test). All patients experienced an improvement in mean CBF in at-risk ROIs after angioplasty, with the mean CBF improving to above 20 ml/100 g/minute in all cases. No differences in the degree of improvement were found in patients who received intraarterial papaverine compared with those who did not. In the majority of patients with refractory vasospasm following SAH, angioplasty effectively dilated spastic arteries, reversed delayed neurological deficits, and significantly improved CBF in areas of brain at risk of infarction.