title: Balloon angioplasty for the treatment of vasospasm: results of first 50 cases.
abstract: OBJECTIVE
  To report the results of the first 50 consecutive patients with vasospasm secondary to subarachnoid hemorrhage treated with balloon angioplasty after failure of medical management.
  
  
  METHODS
  Retrospective uncontrolled study of 50 consecutive patients treated with balloon angioplasty between February 1988 and July 1992. Forty-six had objective clinical deterioration despite maximal medical therapy, whereas four were treated on the basis of rapidly accelerating transcranial Doppler velocities and decreased regional blood perfusion detected by technetium-99m-exametazime brain single photon emission computed tomography. All patients had evidence of marked vasospasm demonstrated by angiography. Thirty-two (64%) and 46 (92%) patients underwent angioplasty within 12 and 18 hours, respectively.
  
  
  RESULTS
  Of the patients with clinical evidence of vasospasm-induced ischemia, 28 (61%) showed sustained neurological improvement within 72 hours of angioplasty. Three (6%) patients deteriorated within 72 hours after angioplasty, with two (4%) patients dying immediately after angioplasty as a result of vessel rupture and the other patient's Glasgow Coma Scale score decreasing by 2. Two additional patients in poor condition with Hunt and Hess Grade V at the time of angioplasty subsequently died during hospitalization. Two other patients died as a result of unclipped aneurysms that subsequently bled 4 and 12 days after angioplasty, respectively. The improvement demonstrated clinically, angiographically, and by transcranial Doppler after angioplasty was sustained, with only one patient requiring subsequent angioplasty of a previously dilated segment (total, 170 vessel segments dilated). Two patients developed vasospasm in previously undilated segments.
  
  
  CONCLUSIONS
  Timely balloon angioplasty can reverse delayed ischemic deficit caused by vasospasm in patients for whom medical therapy has failed.
authors.affiliation: Department of Neurological Surgery, University of Washington School of Medicine, Seattle 98195, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Eskridge
authors.forename: W
authors.initials: W
authors.lastname: McAuliffe
authors.forename: J K
authors.initials: JK
authors.lastname: Song
authors.forename: A V
authors.initials: AV
authors.lastname: Deliganis
authors.forename: D W
authors.initials: DW
authors.lastname: Newell
authors.forename: D H
authors.initials: DH
authors.lastname: Lewis
authors.forename: M R
authors.initials: MR
authors.lastname: Mayberg
authors.forename: H R
authors.initials: HR
authors.lastname: Winn
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation; D002533:Cerebral Angiography; D004867:Equipment Design; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019275:Radiopharmaceuticals; D019233:Retreatment; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime