Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: case report.
OBJECTIVE
The effect of transluminal balloon angioplasty on cerebral biochemical monitoring during treatment of severe cerebral vasospasm after subarachnoid hemorrhage (SAH) was investigated.


METHODS
In a 36-year-old man, an anterior communicating artery aneurysm caused an SAH (Hunt and Hess Grade IV, Fisher Grade III). After clipping, intraparenchymal monitoring (intracranial pressure, brain tissue oxygen tension [P(ti)O(2)], and microdialysis sampling of extracellular glucose, lactate, pyruvate, and glutamate) was initiated. Flow velocities obtained by transcranial Doppler sonography increased in the internal carotid artery (ICA)/middle cerebral artery bilaterally.


METHODS
After a decrease of P(ti)O(2) to less than 2 mm Hg and an increase of the lactate-to-pyruvate ratio to 44 in the territorial region of the left ICA, angiography demonstrated a 70 to 80% stenosis of the left ICA, which was dilated by a temporary occlusion balloon. This maneuver normalized the ICA diameter, P(ti)O(2) increased immediately from 1.5 to 40 mm Hg, the lactate-to-pyruvate ratio decreased from 44 to 30, and extracellular glucose increased from 0.4 to 0.9 mmol/L. No major changes in glutamate or intracranial pressure were seen. In the clinical follow-up, the patient showed a good recovery 6 months after SAH.


CONCLUSIONS
Transluminal balloon angioplasty led to a continuous and effective resolution of cerebral vasospasm observed by sustained, improved cerebral biochemical parameters. Both P(ti)O(2) and lactate-to-pyruvate ratio might provide an early diagnosis of severe cerebral vasospasm after SAH and continuous surveillance of threatened tissue regions after transluminal balloon angioplasty.
Hoelper
Bernd Manfred
BM
Department of Neurosurgery, Klinikum Fulda, Academic Hospital of Philips University Marburg, Fulda, Germany. hoelper@online.de
Hofmann
Erich
E
Sporleder
Roland
R
Soldner
Florian
F
Behr
Robert
R
D000328:Adult; D000800:Angioplasty, Balloon; D001783:Blood Flow Velocity / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism; D001921:Brain / Q000098:blood supply*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000503:physiopathology / Q000628:therapy; D002533:Cerebral Angiography; D004734:Energy Metabolism / Q000502:physiology*; D018698:Glutamic Acid / Q000378:metabolism; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology*; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy*; D019289:Pyruvic Acid / Q000097:blood; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D020301:Vasospasm, Intracranial / Q000503:physiopathology / Q000628:therapy*
D001786:Blood Glucose; D019344:Lactic Acid; D018698:Glutamic Acid; D019289:Pyruvic Acid